There are researchers who believe that the odds of having medication errors occur during a hospital stay increase with the number of medications a patient is taking, due to an increased risk of drug-drug interactions, drug-disease interactions and wrong drug/dose errors. In an opinion piece published by Quartz, the authors suggest that patients should stop all home medications upon hospital admission (unless there is a compelling reason not to) and not resume those medications after discharge (unless there is a compelling medical reason to continue).
Medication Streamlining Process
Upon admission to the hospital, the authors recommend that healthcare providers utilize lists outlining “never stop” medications, which have proven to impact survival, and “almost always stop” medications, which target symptoms but don’t affect survival, to determine which medications to keep patients on.
They acknowledge that coming up with credible lists of “never stop” and “almost always stop” medicines would be a time-consuming task, and the list would have to be endorsed by professional associations of physicians, nurses and pharmacists. In addition, at all times clinical judgement would trump any list rule and patients would be involved in these decisions as much as possible.
Benefits of Simplifying Drug Regimens
The authors claim that discontinuing home medications increases patient safety by simplifying drug regimens, and promotes more control and awareness of the treatments patients are receiving. A nationwide study looking at the prevalence of inappropriate drug use found that among older adults taking medication, 42.6% were on at least one inappropriate medication. As such, the authors argue that stopping all nonessential medications at the time of admission allows clinicians to identify those that may not be benefitting the patient, and reevaluate the complete medication regimen, ensuring there are no negative medication interactions.
Additionally, research shows that as the number of medications patients are on goes up, their overall adherence goes down. Given that in the United States it is common for older patients to be on an average of 9 or 10 medications when they are admitted to a hospital, stopping medications upon admission may result in an eventual reduction in the number of medications, helping patients remain adherent and follow their care plan.
Managing Home Medications in the Hospital
When a patient’s home medications are required, having a way to safely manage them is important. Using patient specific bins in the hospital’s automated dispensing cabinets (ADCs) enables nurses to store a patient’s medications that can be used on multiple occasions, such as creams, inhalers and eye drops. This system creates a closed-loop distribution process that greatly reduces the risk of medication errors and streamlines medication management.
While the proposal to reduce medications was expressed in an opinion piece, the fact remains that patients should be honest with their physicians about all medications they take at home, including over-the-counter and herbal supplements, ensuring the physician has the most accurate information while making care decisions.