Adverse Drug Events Due to Medication Changes

Adverse Effects of Drug Changes When Patients Are Transferred Between Nursing Homes and Hospitals

NEW YORK, NY — March 19, 2004 — Discontinuing medication or changing drug dosages of elderly patients who are transferred between nursing homes and hospitals may lead to unwanted drug reactions, according to a recent report (Arch Intern Med. 2004 Mar 8;164(5): 545–50). Drug information may be inaccurately transcribed because most nursing homes and hospitals do not share medical records, medication ordering systems, or pharmacies, the authors noted. Poor communication between facilities adds to the problem.

Eighty–seven residents of four New York City nursing homes participated in the study. Sixty-four were admitted to the hospital once and 23 more than once, for a total of 122 admissions. A review of nursing home and hospital medical records identified changes in drug type, dosage and frequency at both sites. Two physicians reported on serious drug reactions, known as adverse drug events (ADEs), linked to medication changes.

ADEs occurred in some patients who were transferred from nursing homes to hospitals and changed medications. ADEs also occurred in some patients transferred from hospitals to nursing homes. In most cases, the ADE happened once a nursing home resident returned to the nursing home after a period of hospitalization. Out of 71 such nursing home readmissions, there were 14 ADEs (20%) associated with medication changes. The nursing homes did not necessarily review the patient medication changes made by the hospital.

The study authors recommend that nursing home staff pay special attention to the returning nursing home patient, identifying and correcting any medication changes that occurred during hospitalization that now have the potential to be harmful. A clinical pharmacist should help with this task. The researchers also recommend improved transfer documentation and telephone communication. Health facilities run by the Department of Veterans Affairs keep electronic medical records that are available to both hospitals and nursing homes. Perhaps such a shared electronic medical record can help prevent errors and ADEs, the study authors suggest.

The study also implies that elderly patients can be harmed from discontinuing medication. Although overmedication with multiple drugs is one of the most frequently cited hazards for seniors, some reports show that the abrupt discontinuation of medication during hospitalization may be more risky than the tapered withdrawal of a medication at a nursing home.

At Brayton Purcell, we are concerned about senior health care in nursing homes and hospitals. We are experienced advocates in the areas of elder abuse, nursing home abuse, and pain management. If you have a question about the legal rights of your elderly relative in a nursing home or hospital, please feel free to contact us.

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Suggestions for Patient Transfers Between Facilities:

• Use electronic records to minimize adverse drug events.
• Have pharmacist evaluate medication when the patient is readmitted to the nursing home.

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