360 CHAPTER 4.3 Frequency and type of medication errors identified at readmission Potentially preventable DRAs were caused by oneME in 68 out of 72 patients (94.4%), two MEs in three patients (4.2%), and three MEs in one patient (1.4%). MEs were adjudicated as the main cause for admission in 68.8% of cases and as a contributory cause in 31.2% of cases. Underuse was the most frequently identifiedME type (49.3%), followed by overuse (36.4%), and misuse (14.3%). The top three clinical presentations of potentially preventable DRAs were heart failure exacerbation (26.0%), fall or fracture (20.8%), and bleeding (10.4%). A detailed overview of the frequency, type, and detectability of MEs is provided in Table 2. Detectability of MEs at index hospitalisation (screening question 1) Over half of the total identified MEs at readmission (52.0%, n = 40/77) were present at the time of the in-hospital medication review at index hospitalisation. In the remaining 48.0% (n = 37/77) of cases, the ME was not present and therefore not detectable during the in-hospital medication review; in these cases, either the inappropriate prescription (51.4%, n = 19/37) or the medical condition (48.6%, n=18/37) related to the ME were not present (Figure 3). Detection of present MEs by STOPP/START (screening question 2) The STOPP/START tool detected 60.0% (n = 24/40) of MEs that were present during the in-hospital medication review (Figure 3). Present MEs related to nonneuropathic pain (n = 2), acute renal impairment (n = 2), hyperglycaemia (n = 2) and tremor (n=2) were in no case detected by the STOPP/START tool (Table 2). Recommendations by the pharmacotherapy team (screening question 3) In 54.2% (n = 13/24) of MEs detected by STOPP/START, the signal resulted in a recommendation to change the patient’s medication regimen. In the other 45.8% (n = 11/24), the pharmacotherapy team decided that a change in medication regimen was not clinically applicable based on the patient’s medical status at the time of the in-hospital medication review (Figure 3). These rejected signals did not result in a recommendation to be discussed with the attending physician and patient or deferred to the GP. The pharmacotherapy team recommended a change in medication in 43.7% (n = 7/16) of present MEs that were not detected by STOPP/START (i.e., non-STOPP/ START recommendation) (Figure 3). Overall, the pharmacotherapy team recommended a change in medication regimen in 50% (n = 20/40) of present MEs (Figure 3).
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