Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Welk, Blayne

2nd Supervisor

Garg, Amit

Abstract

Medication errors and discrepancies occur frequently at transitions of care in inpatient settings and can lead to adverse drug events. This retrospective cohort study involving older adults has a pre-post design and is set in London, Ontario. This study evaluates the impact of a healthcare technology program called HUGO on the proportion of patient hospitalizations in which an antipsychotic, benzodiazepine or gastric acid suppressant medication was potentially continued inappropriately (i.e. continued after discharge with no medical indication for continued use). After HUGO’s implementation, the proportion of hospitalizations where a potentially inappropriate antipsychotic, benzodiazepine, or gastric acid suppressant medication was filled post-discharge decreased abruptly by 7.0% (p<0.0001), and there was a significant (p=0.0001) decrease in the potentially inappropriate continuation of these medications over time. Had HUGO not been implemented, the pre-HUGO trend suggests that potentially inappropriate continuation of these medications may have continued to increase.

Summary for Lay Audience

During a patients’ hospital stay medication errors can occur such as the wrong dose of a medication being recorded for a patient, or a medication being mistakenly discontinued or continued after hospital discharge. This can cause harm to patients, and sometimes such adverse drug events cause a patient to present to an emergency room and possibly be admitted again to hospital. One way to prevent medication errors from occurring is healthcare providers practicing medication reconciliation, where a patients’ medications are carefully reviewed by a healthcare provider for errors at the time of hospital discharge. Some hospitals have now adopted technology into their healthcare practices to improve patient safety, including moving to an electronic format of medication reconciliation. Hospitals in London, Ontario adopted such a healthcare technology program referred to as HUGO. We used health administrative databases to assess whether adopting HUGO was associated with fewer patients being continued on antipsychotics, benzodiazepines, and gastric acid suppressant medications after hospital discharge. We found that after HUGO was implemented there was a significant decrease in the number of patients being continued on these medications after hospital discharge We suggest that implementation of HUGO in London’s hospitals has had a positive impact and that other hospitals could look at implementing a program similar to HUGO.

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