Many hospitalized patients remain on medications long after they were meant to stop due to documentation and handoff breakdowns, Medscape reported Feb. 17.
Here’s what to know:
1. The problem is most likely to affect patients who are older or have advanced diseases.
2. The medication burden usually starts in the emergency department, where hospitalists are less likely to have access to outpatient provider notes.
“The times that I see the medication burden increase most significantly during hospitalizations is when there are multiple handoffs between providers,” Ryan Buck, MD, a hospitalist and assistant professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, told Medscape. “Sometimes there isn’t good communication about why a new medicine has already been started or providers might have slightly different ideas or opinions about the best way to treat a certain condition but then don’t necessarily stop the previous treatments that have already been started.”
3. Statins, aspirin, proton pump inhibitors and high-risk medications such as anticoagulation, insulin, oral hypoglycemics and antiplatelets are the most likely medications to persist at discharge without unclear ongoing indications.
4. The issue is often traced back to incomplete or inaccurate records. If medication intent isn’t clearly structured or consistently visible across care settings, physicians are less likely to discontinue the medication. Instead, hospitalists often defer to the outpatient primary care of sub-specialty physicians since they will be with these patients longer.
5. Resolving this issue would require better documentation, especially in discharge paperwork, on which medications should be continued, discontinued, paused, modified or newly prescribed.
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