Sources of medication omissions among hospitalized older adults with polypharmacy
Background Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to ob...
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Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2022-04, Vol.70 (4), p.1180-1189 |
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creator | Shah, Avantika Saraf Hollingsworth, Emily Kay Shotwell, Matthew Stephen Mixon, Amanda S. Simmons, Sandra Faye Vasilevskis, Eduard Eric |
description | Background
Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies.
Methods
Cross‐sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post‐acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies.
Results
Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources—pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies.
Conclusion
A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices. |
doi_str_mv | 10.1111/jgs.17629 |
format | Article |
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Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies.
Methods
Cross‐sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post‐acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies.
Results
Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources—pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies.
Conclusion
A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.17629</identifier><identifier>PMID: 34967444</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; best possible medication history ; Cross-Sectional Studies ; Electronic medical records ; Hospitalization ; Humans ; medication errors ; Medication Reconciliation ; Older people ; Patient Discharge ; Patients ; Pharmacy ; Polypharmacy ; Skilled Nursing Facilities</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2022-04, Vol.70 (4), p.1180-1189</ispartof><rights>2021 The American Geriatrics Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.</rights><rights>2022 American Geriatrics Society and Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4439-977d059cea3b0ab43df48f3832541e9e2f576b48126dd925e664da6748a0963e3</citedby><cites>FETCH-LOGICAL-c4439-977d059cea3b0ab43df48f3832541e9e2f576b48126dd925e664da6748a0963e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.17629$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.17629$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34967444$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shah, Avantika Saraf</creatorcontrib><creatorcontrib>Hollingsworth, Emily Kay</creatorcontrib><creatorcontrib>Shotwell, Matthew Stephen</creatorcontrib><creatorcontrib>Mixon, Amanda S.</creatorcontrib><creatorcontrib>Simmons, Sandra Faye</creatorcontrib><creatorcontrib>Vasilevskis, Eduard Eric</creatorcontrib><title>Sources of medication omissions among hospitalized older adults with polypharmacy</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Background
Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies.
Methods
Cross‐sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post‐acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies.
Results
Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources—pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies.
Conclusion
A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.</description><subject>Aged</subject><subject>best possible medication history</subject><subject>Cross-Sectional Studies</subject><subject>Electronic medical records</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>medication errors</subject><subject>Medication Reconciliation</subject><subject>Older people</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Polypharmacy</subject><subject>Skilled Nursing Facilities</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kV1rFDEYhUOxtGvtRf9ACXhTL6bN98eNIEutloJI9TpkJ5ndLJnJmMxY1l9vdGuxgu9NXsjD4Zz3AHCG0SWuc7Vdl0ssBdEHYIE5JQ1nmL8AC4QQaZTA7Bi8LGWLECZIqSNwTJkWkjG2AJ_v05xbX2DqYO9daO0U0gBTH0qpS4G2T8MablIZw2Rj-OEdTNH5DK2b41TgQ5g2cExxN25s7m27ewUOOxuLP318T8DX99dflh-au083H5fv7pqWMaobLaVDXLfe0hWyK0Zdx1RHFSXVvNeedFyKFVOYCOc04V4I5mx1rSzSgnp6At7udcd5VZ23fpiyjWbMobd5Z5IN5vnPEDZmnb4bpZXgUlWBi0eBnL7Nvkymhm59jHbwaS6GCMyZlESSir7-B93Wsw01XqWYrDm4kJV6s6fanErJvnsyg5H5VZSpRZnfRVX2_G_3T-SfZipwtQceQvS7_yuZ25v7veRPSjCeLw</recordid><startdate>202204</startdate><enddate>202204</enddate><creator>Shah, Avantika Saraf</creator><creator>Hollingsworth, Emily Kay</creator><creator>Shotwell, Matthew Stephen</creator><creator>Mixon, Amanda S.</creator><creator>Simmons, Sandra Faye</creator><creator>Vasilevskis, Eduard Eric</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202204</creationdate><title>Sources of medication omissions among hospitalized older adults with polypharmacy</title><author>Shah, Avantika Saraf ; Hollingsworth, Emily Kay ; Shotwell, Matthew Stephen ; Mixon, Amanda S. ; Simmons, Sandra Faye ; Vasilevskis, Eduard Eric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4439-977d059cea3b0ab43df48f3832541e9e2f576b48126dd925e664da6748a0963e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>best possible medication history</topic><topic>Cross-Sectional Studies</topic><topic>Electronic medical records</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>medication errors</topic><topic>Medication Reconciliation</topic><topic>Older people</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>Pharmacy</topic><topic>Polypharmacy</topic><topic>Skilled Nursing Facilities</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shah, Avantika Saraf</creatorcontrib><creatorcontrib>Hollingsworth, Emily Kay</creatorcontrib><creatorcontrib>Shotwell, Matthew Stephen</creatorcontrib><creatorcontrib>Mixon, Amanda S.</creatorcontrib><creatorcontrib>Simmons, Sandra Faye</creatorcontrib><creatorcontrib>Vasilevskis, Eduard Eric</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shah, Avantika Saraf</au><au>Hollingsworth, Emily Kay</au><au>Shotwell, Matthew Stephen</au><au>Mixon, Amanda S.</au><au>Simmons, Sandra Faye</au><au>Vasilevskis, Eduard Eric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sources of medication omissions among hospitalized older adults with polypharmacy</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2022-04</date><risdate>2022</risdate><volume>70</volume><issue>4</issue><spage>1180</spage><epage>1189</epage><pages>1180-1189</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>Background
Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies.
Methods
Cross‐sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post‐acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies.
Results
Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources—pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies.
Conclusion
A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34967444</pmid><doi>10.1111/jgs.17629</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; Access via Wiley Online Library |
subjects | Aged best possible medication history Cross-Sectional Studies Electronic medical records Hospitalization Humans medication errors Medication Reconciliation Older people Patient Discharge Patients Pharmacy Polypharmacy Skilled Nursing Facilities |
title | Sources of medication omissions among hospitalized older adults with polypharmacy |
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