Unintentional Discontinuation of Medications

Patients who are discharged from hospitals may be at risk for unintentional discontinuation of medications prescribed for chronic diseases. Treatment in the intensive care unit may place patients at an elevated risk since the focus is on acute care and there is the danger of incomplete communication as responsibility shifts from one physician to another.

The downstream effect of unintentional discontinuation of medications varies in severity according to the medication group. Discontinuing gastric acid suppressors may result in heartburn, but stopping an anticoagulant such as warfarin could increase the risk of stroke. Prescription errors may occur as medications for chronic diseases are not restarted when the acute episode resolves; patients may be without their medications for the remainder of their hospital stay and after discharge.

There are several important steps that physicians can take to improve patient safety and to minimize gaps in patient care. Hospitals are ‘graded’ on these efforts.  Discharge planning starts at hospital admission, but errors of omission are difficult to spot. It is important for patients (and their families) to play an active role in the transition between the hospital and the community. After hospitalization the list of medications should look very much like the list before hospitalization – if not, find out why a change was made. This is especially important in the case of elective surgery.

JAMA, 2011;306(8):840-847