369 Detectability of medication errors in older people prior to potentially preventable admissions criteria, it should be noted that the population included in this substudy was relatively functionally independent with a considerably high Barthel Index (median 90; IQR 70–100), which was comparable to the baseline characteristics of participants in the main OPERAM trial. In addition, only a small proportion of nursing home residents were included. Hence, our findings may not be generalisable to frailer populations. Although DRA adjudication remains partially subjective and variability between teams of adjudicators cannot be completely ruled out, the adjudication process was performed by skilled senior clinicians (blinded for the allocation group) using a standardised DRA adjudication guide that has proven to effectively identify DRAs in older people [14,63]. The presence of MEs during in-hospital medication review was retrospectively assessed for those MEs identified by the DRA adjudication teams at readmission. However, information on drug use, laboratory values, medical conditions, and acceptance of STOPP/START signals was prospectively collected at the time of the in-hospital medication review. Therefore, this information can be considered of high quality. This study has several limitations. First, the sample of MEs described in the study was rather small and heterogeneous which impedes the drawing of firm conclusions. Second, data to assess ME detectability were not available for OPERAM control patients with a potentially preventable DRA, because no in-hospital medication review was performed. Therefore, the study results could not be compared with a control group. Third, the reasons for not recommending medication changes by the pharmacotherapy teams for MEs present at the time of medication review were not available. However, decisions of the pharmacotherapy teams were made after careful evaluation of a patient’s medical record at the time of the medication review and therefore considered appropriate. Re-evaluation of these decisions would introduce information bias. Nonetheless, it is possible that present MEs not detected by STOPP/ START and in which no medication change was recommended, were missed by the pharmacotherapy teams during the in-hospital medication review. Finally, a relatively large proportion of MEs were excluded from analysis due to missing data, but the reasons for the missing data were unrelated to the study outcome. Therefore, these omissions are unlikely to have affected the findings. Conclusion Overall, MEs identified at readmission were not addressed by a prior single inhospital 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. 4
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