Hospitals that reduce patient medications may improve patient safety

Hospitals that reduce the number of medications a patient takes could improve patient safety under the theory that the fewer medications given, the less chance of a medication error, according to an opinion piece at Quartz, a digital news outlet.

To reduce the number of medications, doctors should stop all home medications when a patient is admitted unless there is a compelling medical reason to continue them while in the hospital, according to authors Bruce L. Lambert, Ph.D., a Northwestern University professor; William Galanter, M.D., Ph.D., associate chief health information officer at the University of Illinois Hospital and Health Sciences System; and Robert McNutt, M.D., associate editor at the Journal of the American Medical Association.

And when a patient is discharged, doctors should not resume any medications that he or she was previously taking unless there is a compelling reason to do so, the authors wrote.

Along with increasing safety, fewer medications can also make a patient's stay less expensive, they note. Medication errors are a major problem in hospitals, with the Institute of Medicine estimating that the rate is one error per patient per day. In the United States is it common for patients to be on an average of nine or 10 medications when they are admitted to a hospital, according to a 2010 study.

"The more medicines a person is on, the more difficult it is to care for them safely and effectively," the authors wrote in the Quartz piece. Each new medication creates more opportunities for wrong drug errors and wrong dose errors.

While it might sound reckless to stop a patient's medications while hospitalized, the authors argue that many medications are unnecessary or inappropriate. The challenge for hospitals is to establish a process and a set of decision rules that would allow physicians to identify which medicines to stop and which ones to continue, the authors wrote. For instance, doctors would not discontinue any drug that would affect a patient's survival, such as medications for diabetes or high blood pressure, which would be on a "never stop" list.

Ultimately, a physician's clinical judgment would decide what drugs to discontinue, they wrote. These lists would need to be endorsed by professional associations of physicians, nurses, and pharmacists, who often play a key role in improving patient care and safety.

To learn more:
- read the opinion piece