Dr Krumholz (2013) described post-hospital syndrome as “an acquired, transient condition of generalised risk” affecting some patients who are discharged from hospital¹. Hospitalised patients may not only be suffering from an acute illness, but they may also be under emotional stress due to new information, new circumstances and worrying about their health and social status. Thus, the period immediately following hospital discharge can be a challenging time for patients. Healthcare providers must take extra care in supporting patients at and beyond hospital discharge to help them re-adjust.

When a patient is going home from the hospital, they might leave with new or altered medications. These changes can make getting better at home more complicated as people may experience new side effects or problems taking their medication. Whilst we know about potential problems from medications in people who are in hospital (issues at the point of hospital discharge, while patients are still in the hospital), we do not know much about how often people experience problems and the harm done from their medications once they get back into the community (e.g. back at home)². Medication safety at the transfer of care is therefore an important issue; one of three priorities for action in the World Health Organization’s (WHO) Third Global Patient Safety Challenge: Medication Without Harm in March 2017³.

Our recently published review in Drug Safety⁴ by the research team at the University of Manchester has highlighted that this transition phase from hospital to home is associated with patients experiencing medication errors (errors associated with prescribing, dispensing or administering medication) and medication related harm. Other studies have found these risks are present on admission to hospital and during the inpatient stay. Our paper confirms risk is also present following discharge. Our review summarised all the available international evidence of the burden and type of medication errors and mediation-related injury after hospital discharge from 54 research papers.

Our review found that for adults and the elderly, post-hospital discharge:

• A median of one in two patients may be affected by medication errors, a median rate 53% [Inter Quartile Range (IQR) 33-60.5] (five studies).
• A median of one in five patients may be harmed by their medication, a median rate of 19% [IQR 16-24] (seven studies).

It is time to focus on this stage of care. We found that medication errors and harm they cause commonly affected patients after discharge, with a trend towards older adults being more likely to experience these events. We also identified that medication groups including antibiotics, pain-relief, diabetes and cardiovascular medications were commonly associated with these risks.

Our review reveals that medication safety challenges are common following hospital discharge to the community and is an important consideration for researchers and health care institutions. We have identified key targets that may be used to focus future research, and gained a better understanding of the causes of these risks. Our findings may also be used to plan interventions designed to improve safety at this important stage of the patient care journey.

1. Krumholz, H.M. Post-hospital syndrome–a condition of generalized risk. The New England journal of medicine. 2013; 368(2): p.100.
2. Michaelsen M, McCague P, Bradley C, Sahm L. Medication reconciliation at discharge from hospital: a systematic review of the quantitative literature. Pharmacy. 2015; 3:53–71.
3. World Health Organization. Global patient safety challenge: medication without harm. 2017; p. 1–16. http://apps.who.int/iris/bitstream/10665/255263/1/WHO-HIS-SDS-2017.6-eng.pdf?ua=1&ua=1 . Accessed 17 Apr. 20 2020.
4. Alqenae, F, Steinke, D & Keers, R 2020, ‘Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review’, Drug Safety, 2020; 43(6):517-537

By Fatema Alqenae (PhD Candidate – Fatema.alqenae@postgrad.manchester.ac.uk)