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Around 7% of medication changes requested by hospital teams post-discharge were not actioned by GP teams, results from a retrospective cohort study have suggested.
The results also showed that error and harm disproportionately affected patients with dementia or a recorded carer.
Researchers reviewed electronic patient records for 263 patients aged 65 years or older who were discharged from hospitals in the West Midlands between October 2022 and October 2023.
In total, 551 actions were requested by hospital teams in the discharge summary, including 384 medication change requests. Of these, 266 were requests to start a new repeat medication, 76 to discontinue and 42 to change a dose.
However, just under 10% of actions (n=50) were not completed with no explanation recorded in the patient record. Of these, 30 were medication-related, the majority of which (n=24) related to new repeat medication.
These errors affected 13% of patients involved in the study and 4% of patients experienced harm, most of which were preventable and resulted in hospital readmission.
The study concluded: “General practice needs to review their processes for responding to patient discharge information in order to improve patient safety post-discharge. Further research into tools to assist practice with transitions is warranted.”
Commenting on the study, Claire Anderson, Royal Pharmaceutical Society president, said: “This study highlights the importance of getting medicines right when patients move from hospital to home, particularly for older people with complex needs.
“Pharmacists based in hospitals, general practice and the community play a key role in checking changes to medicines, supporting patients to understand their treatment and preventing avoidable harm and hospital readmissions.
“Better communication and interoperable patient records across care settings are essential to ensure information flows between teams and patients receive the right support after discharge.”
Malcolm Harrison, chief executive of the Company Chemists’ Association, which represents large community pharmacy chains, said: “These findings illustrate exactly why the discharge medicines service (DMS) is important.”
Under the DMS, hospitals in England can refer patients to a community pharmacy upon discharge. The pharmacy then checks that any changes requested have been actioned by the GP, and contacts the patients to ensure they understand any changes to their medication.
“Pharmacists are experts in medicines and ideally placed to improve patient care as they leave hospital. Despite the proven effectiveness of the service, patients are unfortunately subject to a postcode lottery in accessing this care,” Harrison added.
“Embedding DMS into patient discharge pathways across all NHS hospital trusts will help improve patient outcomes. Avoidable readmissions to hospital are costly to the NHS, taxpayers and patients. The money currently spent on readmissions should be spent in primary care which is significantly underfunded.
“As a constituent part of primary care, community pharmacy can provide practical solutions to relieve pressures on the wider NHS, such as through the DMS, but this can only happen in a system that is properly funded.”
