Detectability of Medication Errors With a STOPP/START-Based Medication Review in Older People Prior to a Potentially Preventable Drug-Related Hospital Admission

Abstract

Introduction: Multimorbidity and polypharmacy are risk factors for drug-related hospital admissions (DRAs) in the ageing population. DRAs caused by medication errors (MEs) are considered potentially preventable. The STOPP/START criteria were developed to detect potential MEs in older people.

Objective: The aim of this study was to assess the detectability of MEs with a STOPP/START-based in-hospital medication review in older people with polypharmacy and multimorbidity prior to a potentially preventable DRA.

Methods: Hospitalised older patients (n = 963) with polypharmacy and multimorbidity from the intervention arm of the OPERAM trial received a STOPP/START-based in-hospital medication review by a pharmacotherapy team. Readmissions within 1 year after the in-hospital medication review were adjudicated for drug-relatedness. A retrospective assessment was performed to determine whether MEs identified at the first DRA were detectable during the in-hospital medication review.

Results: In total, 84 of 963 OPERAM intervention patients (8.7%) were readmitted with a potentially preventable DRA, of which 72 patients (n = 77 MEs) were eligible for analysis. About half (48%, n = 37/77) of the MEs were not present during the in-hospital medication review and therefore were not detectable at that time. The pharmacotherapy team recommended a change in medication regimen in 50% (n = 20/40) of present MEs, which corresponds to 26% (n = 20/77) of the total identified MEs at readmission. However, these recommendations were not implemented.

Conclusion: MEs identified at readmission were not addressed by a prior single in-hospital medication review because either these MEs occurred after the medication review (~50%), or no recommendation was given during the medication review (~25%), or the recommendation was not implemented (~25%). Future research should focus on optimisation of the timing and frequency of medication review and the implementation of proposed medication recommendations.

Registration: ClinicalTrials.gov identifier: NCT02986425. December 8, 2016.

Funding: European Union HORIZON 2020, Swiss State Secretariat for Education, Research and Innovation (SERI), Swiss National Science Foundation (SNSF).

Conflict of interest statement

Bastiaan T.G.M. Sallevelt, Toine C.G. Egberts, Corlina J.A. Huibers, Jimmy Ietswaart, A. Clara Drenth-van Maanen, Emma Jennings, Cian O’Mahony, Katharina Tabea Jungo, Martin Feller, Nicolas Rodondi, François-Xavier Sibille, Anne Spinewine, Eugène van Puijenbroek, Ingeborg Wilting and Wilma Knol have no conflicts of interest related to the content of this article.

© 2022. The Author(s).

Figures

Fig. 1

Graphical illustration of the relationship between the in-hospital medication review at index hospitalisation and the adjudication process of hospital readmissions within 1 year after the in-hospital medication review. CDSS clinical decision support system, DRA drug-related hospital admission, GP general practitioner, STOPP/START v2 Screening Tool of Older Person’s Prescriptions / Screening Tool to Alert doctors to Right Treatment, version 2

Fig. 2

Flowchart of the study population. DRAs were considered potentially preventable if medication errors were the main or contributory cause of the readmission. Non-preventable DRAs were caused by non-preventable adverse drug reactions. DRA drug-related hospital admission

Fig. 3

Flowchart of the detectability of medication errors (MEs) at the time of the in-hospital medication review, based on the three screening questions used for detectability assessment. START Screening Tool to Alert doctors to Right Treatment, STOPP Screening Tool of Older Person’s Prescriptions

Fig. 4

Cumulative incidence (%) of medication errors (MEs) over time stratified for total, present and not present MEs during the in-hospital medication review