Most cardiac patients commit medication errors after discharge

Only 40 percent of patients with acute coronary syndrome or acute decompensated heart failure in a prospective study were able to correctly identify individual medications, dose and frequency after they left the hospital, highlighting a major problem.

Medication errors can be fatal, particularly when medications are taken that contraindicate each other or incorrect dosage is used. Low health literacy, discordant medication, unreported medications, lack of understanding of the dose, frequency or indications of a medication were all aspects of patient medication errors noted by the research team.

“Based on prior literature, we were not surprised that over half of patients had a discordant medication after discharge,” stated lead author Amanda S. Mixon, MD, MS, MSPH, of the Tennessee Valley Health Care System in Nashville, in an email exchange with Cardiovascular Business. “However, we were surprised to find almost 60% of patients had a misunderstanding about the indication, dose, or frequency of at least 1 medication.”

Of the patients followed, 51.4 percent were discordant in their medication practices, meaning they were taking one or more medication they were either not prescribed at discharge or were not taking one or more medications prescribed. Low health literacy and numeracy were a problem in 59.2 percent of cases, leading to misunderstandings of frequency, dose and indications of a medication.

On the other hand, higher health literacy and numeracy were factors in lowering odds of medication errors. Numeracy is defined as the understanding and ability to use numbers in daily life.

When asked how doctors and hospitals could apply their findings going forward, Mixon suggested the use of clear language to explain medication changes to patients who are older with little support or who show low health literacy, numeracy or have cognitive impairment. Patients who are depressed are also at high risk and should be carefully counseled on their medications prior to release.

“Our hospital has implemented the 3-item Brief Health Literacy Screen into the electronic medical record for inpatient and outpatient encounters,” she wrote. “This allows the provider to be more savvy in discussing medications, as well as other care, with patients.”

Mixon stated that the team hopes to build off of this and prior research to test interventions targeting low health literacy and numeracy with discharge medication counseling to further reduce post-discharge medication errors.

The study was published July 3 in Mayo Clinic Proceedings.