gms | German Medical Science

19. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

22.11. - 23.11.2012, Jena

Comparing safety of prescribing at hospital admission versus discharge and assessing information on medication-related risks in discharge letters

Meeting Abstract

  • corresponding author Wilko von Klüchtzner - Institut für Arzneitherapiesicherheit des Universitätsklinikum Essen und des Klinikum Saarbrücken gGmbH, Essen, Germany
  • author Hubert Schneemann - Apotheke des Universitätsklinikum Essen, Essen, Germany
  • author Daniel Grandt - Institut für Arzneitherapiesicherheit des Universitätsklinikum Essen und des Klinikum Saarbrücken gGmbH, Saarbrücken, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 19. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Jena, 22.-23.11.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12gaa05

doi: 10.3205/12gaa05, urn:nbn:de:0183-12gaa050

Veröffentlicht: 14. November 2012

© 2012 von Klüchtzner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: The Federal Ministry of Health’s medication safety agenda has initiated concrete action strategies to better understand and reduce the burden of preventable patient harm resulting from inappropriate processes in drug therapy. In this context, analyzing and promoting prescribing safety and continuity at transitions between healthcare sectors has been identified as one of the key issues for research and quality improvement.

Materials and Methods: Between June and October 2011 we consecutively included 200 patients aged ≥18 years who were admitted to medical or orthopedic/surgical wards at Essen University Hospital with at least one previously prescribed medication.

Relying on thoroughly collated seamless medication profiles including relevant patient and morbidity characteristics (Figure 1 [Fig. 1]) we used the clinical decision support software RpDoc® (version 2.4.2) to identify and compare potential prescribing errors in pre-admission and discharge medication regimens.

Additionally, we analyzed to which extent discharge letters duly commented on prescribing risks persisting after in-patient treatment.


Patient characteristics: Out of the 200 recruited patients 13 (6,5%) are lost to follow-up due to the following reasons:

  • N = 11: no discharge letter available
  • N = 1: death during hospitalization (no relation to medication)
  • N = 1: withdrawal of informed consent

Consequently, 187 cases (93,5%) remain for analysis with a statistically balanced distribution between men and women: 98 vs. 89 (p = 0,559). Table 1 [Tab. 1] summarizes additional patient characteristics.

Potential prescribing errors at hospital admission and discharge: Both at hospital admission and discharge nearly 2/3 of the analyzed patients suffer from potentially inadequate prescribing. Also, the number of potential prescribing errors per patient does not change significantly between the two settings (Table 2 [Tab. 2]).

Likewise, during hospitalization there is no significant decrease in the percentage of potentially inadequate prescriptions (Figure 2 [Fig. 2]).

While the overall burden of potentially inappropriate prescribing is not reduced until the end of the hospital stay there are significant modifications in the risk profile that patients are exposed to (Figure 3 [Fig. 3]). Thus, both clinically relevant drug interactions and omissions of absolutely indicated medication affect more patients at discharge than at admission. In contrast, merely the relatively small number of patients with redundant prescriptions can be further lowered during in-hospital care.

Communication of persisting prescribing risks in hospital discharge letters: Hospital discharge letters indicate only 1 in 40 persisting prescribing risks mostly without explaining why they are inevitable (Figure 4 [Fig. 4]).

Conclusion: Insufficient safety of outpatient prescribing is not improved throughout hospitalization.

General practitioners are not adequately informed about persisting prescribing risks when their patients are discharged from hospital.

Standardizing medication history as well as reviewing and reconciling drug therapy at hospital admission and discharge can impede the health threats posed by inappropriate and incoherent prescribing.

Electronic systems can enhance quality and efficiency of a seamless medication process: systematic assessment of pre-admission medication – switching to hospital formulary – continuous medication safety review – determining discharge medication – automated transfer of all necessary information into discharge letter.

More research is needed on

(a) the actual adverse outcomes caused by inappropriate prescribing at the interface between healthcare sectors.

(b) effectiveness and implementation of prescribing safety solutions across the continuum of care.