Predicting medicine related harm in older adults post discharge: an Australian feasibility study.

Abstract

Objectives: To explore the feasibility of identifying older patients at risk of medicine-related harm (MRH) at hospital discharge using a MRH risk-prediction tool, follow them up in the community, and identify the incidence and severity of MRH causing readmission to hospital.

Methods: Patients who were over 65 years admitted to a general medical ward were recruited 48 hours prior to discharge from two hospitals in Queensland, Australia, 19 October 2020 to 15 March 2021. Ward pharmacists predicted the likelihood of MRH post-discharge and confidence in this decision. Participants were followed up until eight weeks post-discharge; data were extracted from hospital records. An expert panel of five senior clinicians assessed structured case summaries of participants who attended hospital within the follow-up 56-day period to determine MRH. MRH risk was assessed using the PRIME (Prospective study to develop a model to stratify the RIsk of Medication-related harm in hospitalized Elderly patients) tool.

Key findings: All 39 patients approached consented; 31 participated in follow-up phone calls. Of these 39, 23 (59%) had one or more readmission within 56 days. Six readmissions in five participants were associated with MRH. Of the MRH, three were definite adverse drug reactions while one was due to medicine non-adherence. MRH was potentially preventable in four cases.

Conclusion: Outcomes show it is feasible to recruit and complete follow-up of older patients in the Australian healthcare system to examine the burden of MRH and use of a risk identification tool.