Table 3.

Final list of potentially preventable medication-related hospitalisations for Indigenous Australians^#

Number	Hospitalisation outcome to avoid	Process of suboptimal clinical care prior to hospitalisation	Source
Haemorrhagic event
1	Haemorrhagic event	Use of warfarin;	Original
		Concurrent use of an interacting antibiotic;
		No INR test in the 5 days prior to admission.
2	Haemorrhagic event	Use of warfarin;	Original†
		No INR test in the 6 weeks prior to admission.
3	Haemorrhagic event	Use of one or more antithrombotics (warfarin, DOAC, aspirin, NSAID, clopidogrel, LMWH); AND	Original†
		No haemoglobin test within the past year; OR
		No monitoring of renal function in the previous 6 months; OR
		Use of triple therapy (dual antiplatelet plus oral anticoagulant) for more than 1 month prior to admission.
Gastrointestinal
4	Gastritis, GI bleed, GI ulcer or GI perforation	History of or prior hospitalisation for GI ulcers or GI bleed;	Original†
		Use of NSAID (including aspirin) for a period of at least 1 month prior to admission.
5	Gastritis, GI bleed, GI ulcer or GI perforation	History of prior hospitalisation for GI ulcers or GI bleed; AND	Original†
		Use of gastric toxin (eg, oral corticosteroids, NSAIDs, antiplatelet agents, bisphosphonates, anticoagulants, cholinesterase inhibitor) for a period of at least 3 months prior to admission; AND
		No cytoprotection (eg, proton pump inhibitor).
6	Bowel impaction	Use of two or more medications known to retard gastrointestinal motility (including anticholinergic agents, calcium channel blockers, antacids and iron preparations) at the time of admission; OR	Original†
	Use of a highly anticholinergic agent at the time of admission; OR
		Use of an opioid analgesic without concurrent use of a laxative at the time of admission.
Cardiovascular
7	Congestive heart failure or fluid overload	Prior hospitalisation for/or diagnosis of high blood pressure or CHF;	Original†
		Use of an agent known to exacerbate CHF including NSAIDs, COX-2 inhibitors, anti-arrhythmics (apart from beta-blockers or amiodarone), non-dihyropyridine calcium-channel blockers in systolic CHF (verapamil, diltiazem), corticosteroids, clozapine, tricyclic anti-depressants, tyrosine kinase inhibitors, thiazolidinediones or tumour necrosis factor antagonists at time of admission.
8	Congestive heart failure or fluid overload	Prior hospitalisation for/ or diagnosis of heart failure;	Original
		No use of ACEI, ARB or ARNi (angiotensin receptor neprilysin inhibitor) at time of admission.
9	Myocardial Infarction	History of acute coronary syndrome / previous MI;	Original†
		No use of anti-platelet(s) OR beta-blocker (reduced left-ventricular systolic function only) OR HMG-CoA reductase inhibitor in the 3 months prior to hospitalisation.
10	Myocardial infarction	Insertion of stent within the previous 12 months;	New
		No use of dual anti-platelet in 2 months prior to admission.
11	Thromboembolic cerebrovascular event	Prior diagnosis of atrial fibrillation;	Original†
		No use of anticoagulant in the 3 months prior to admission in a patient with high risk according to CHA2Ds2Vasc score.
12	Acute coronary syndrome	CVD risk known to be >15% prior to admission;	New
		Not on lipid lowering therapy AND/OR antihypertensive therapy.
13	Transient ischaemic attack/ischaemic stroke	Pulse quality/blood pressure not tested within past 24 months;	New
		No use of any of antiplatelet, antihypertensive, anticoagulant, lipid lowering therapy.
14	Ischaemic coronary event	History of angina or acute coronary syndrome;	New
		No use of beta-blocker, calcium channel blocker or nitrates.
15	Ischaemic event	History of diabetes;	New
		History of ischaemic event;
		No antiplatelet or lipid lowering therapy.
Electrolytes and laboratory abnormalities
16	Blood dyscrasia	Use of an agent known to cause blood dyscrasias (including carbimazole, sulphonylureas, propylthiouracil, methotrexate, sulphasalazine);	Original†
		No complete blood count or platelet test in the 6 months prior to admission.
17	Syndrome of inappropriate antidiuretic hormone secretion	Use of TCAs, carbamazepine, ACEIs, other antidepressants;	Original†
		No electrolyte test in the 12 months prior to admission.
18	Electrolyte imbalance	Use of diuretics, ACEI/ARB, spironolactone, potassium supplements or calcium supplements;	Original†
		No electrolyte test in the 12 months prior to admission; AND
		No renal function test in the 12 months prior to admission.
19	Anticonvulsant drug toxicity	Use of anticonvulsant requiring therapeutic drug monitoring;	Original
		No drug level test in the 6 months prior to admission.
20	Digoxin toxicity	Use of digoxin;	Original†
		No renal function test in the 12 months prior to admission; AND
		No potassium serum level in the 6 months prior to admission.
21	Lithium toxicity	Use of lithium;	Original
		No lithium drug level test in the 3 months prior to admission.
22	Clozapine-related blood dyscrasias	Use of clozapine;	New
		No full blood count/white blood count/neutrophils/ eosinophils in >1 month prior to admission or within the previous week in the first 18 weeks of therapy.
23	Clozapine-induced myocarditis/cardiomyopathy	Use of clozapine;	New
		No baseline echocardiogram; OR
		ECG in the previous 12 months; OR
		troponin in the previous 12 months; OR
		CRP in previous 12 months before admission.
24	Clozapine toxicity/failure	Use of clozapine;	New
		Altered smoking status while on clozapine (may vary levels and result in toxicity or relapse).
25	Clozapine toxicity	Use of clozapine;	New
		Concurrent illness;
		No full blood count/ white blood count/ neutrophils/ eosinophils in >1 month prior to admission.
Endocrine
26	Hypoglycaemia	Use of insulin; OR	Original†
		Use of long-acting sulfonylurea in the 3 months prior to admission; AND
		Inadequate blood glucose monitoring OR reduced adherence to diabetes treatment plan.
27	Diabetic complications (including hyperglycaemia)	Previously diagnosed with diabetes;	Original†
		Use of a hypoglycaemic in the 6 months prior to admission; AND
		No HbA1c in previous 6 months.
28	Hypothyroidism or thyrotoxicosis	Use of amiodarone or lithium;	Original†
		No thyroid function test in the 6 months prior to admission.
Fracture or falls
29	Hip fracture or other fracture/break	Aged 65 years or older; AND	Original†
		Use of long-term corticosteroids (>1 month); AND/OR
		Use of sedating psychotropic medication (including TCAs, benzodiazepines, antipsychotics, opioids); AND/OR
		Use of cardiovascular drugs with high potential to cause postural hypotension (including nitrates, centrally acting adrenergic blockers and alpha-receptor blockers).
30	Hip fracture	Female gender;	Original
		Prior fall from the standing level resulting in fracture;
		No use of HRT, bisphosphonate or other osteoporosis medicine in the 6 months prior to admission.
31	Hip fracture	Male gender;	Original
		Prior fall from the standing level resulting in fracture;
		No use of bisphosphonate or other osteoporosis medicine in the 6 months prior to admission.
32	Low-trauma fracture	Previous low-trauma fracture;	New
		Not taking osteoporosis prevention therapy at time of admission.
Neurological
33	Acute confusion	Urinary tract infection un/inadequately treated	New
34	Acute confusion	Use of two or more anticholinergic agents at the time of admission; OR	Original†
		Use of a highly anticholinergic agent at the time of admission; OR
		Use of two or more of sedating prescription drugs and/or sedating antihistamines; OR
		Use of multiple psychotropic medicines (≥3 unique medicines from ATC groups, N05 or N06) at the time of admission.
35	Seizure	Use of an anticonvulsant;	Original†
		Concurrent use of a medication which lowers the seizure threshold (as specified in the Australian Medicines Handbook); AND/OR
		Reduced compliance with anticonvulsant medication.
36	Bipolar disorder	Prior hospitalisation for bipolar disorder;	Original
		Use of lithium;
		No lithium drug level in the 3 months prior to admission.
37	Bipolar affective disorder/psychotic disorder	Prior hospitalisation for bipolar disorder;	New
		No use of/ poor compliance with a mood stabiliser; OR
		Reduced compliance with long acting injection and/or oral medication.
38	Depression	Prior diagnosis of depression;	Original
		Concurrent use of a moderately highly lipophilic beta blocker.
39	Depression (readmission)	Reduced compliance with antidepressant or augmenting medications (mood stabiliser or antipsychotic); AND/OR	New
		No review (including medication adherence) undertaken post previous admission.
40	Mania/hypomania	Use of antidepressants in the 2 months prior to admission;	New
		No use of mood stabiliser in the 2 months prior to admission.
41	Attempted suicide	Use of SSRI in adolescents (up to 20 years old);	New
		No psychiatric review in 12 months prior to admission.
42	Psychotic episode	History of psychosis/ mental illness;	New
		Reduced compliance with prescribed antipsychotic/ anxiolytic medication.
43	Antidepressant withdrawal symptoms	Abrupt cessation of antidepressant (especially short-acting such as paroxetine and venlafaxine).	New
44	Acute anxiety	Cessation of psychotropic medications (such as antidepressant and/or benzodiazepines) without monitoring.	New
45	Eating disorder/electrolyte imbalance	Excessive laxative use; OR	New
		Use/abuse of medications altering electrolyte levels (for example, loop diuretics).
46	Serotonin toxicity	Use of multiple serotonergic agents that may contribute to serotonin toxicity (desvenlafaxine, duloxetine, MAOIs including moclobemide, SSRIs, TCAs, venlafaxine, fentanyl, tramadol, selegiline, lithium, tryptophan, St. John’s Wort).	New
Renal
47	Renal failure	Use of ACEI or ARB;	Original†
		No BUN or serum creatinine test in the 12 months prior to admission.
48	Renal failure	Use of allopurinol;	Original
		No BUN or serum creatinine test in the 6 months prior to admission.
49	Renal failure	Use of lithium;	Original
		No BUN or serum creatinine test in the 3 months prior to admission.
50	Renal failure	NSAID use for>3 months;	New
		BUN or serum creatinine not monitored in the previous 12 months.
51	Renal failure	Use of methotrexate;	New
		No BUN or serum creatinine test in the 6 months prior to admission.
Respiratory
52	Asthma AND/OR COPD	Prior hospitalisation for/or diagnosis of asthma/COPD; AND	Original†
		No / inadequate maintenance therapy (LAMA, LABA, ICS); OR
		Poor inhaler technique; AND/OR
		No action plan in place; AND/OR
		No smoking cessation advice given.
53	Asthma/COPD	Prior hospitalisation for/or diagnosis of asthma and/or COPD;	Original
		Use of beta-blocker eye drops for glaucoma at the time of admission.
54	Chronic obstructive pulmonary disease	Prior hospitalisation for/or diagnosis of COPD;	Original
		Use of a betablocker at the time of admission.
55	Acute respiratory failure	Prior hospitalisation for/or diagnosis of COPD;	Original
		Use of a medium to long-acting benzodiazepine at the time of admission.
56	Asthma	Prior hospitalisation for/or diagnosis of asthma/COPD;	New
		High use (>2X per week) of a short-acting bronchodilator (SABA, SAMA);
		No use of maintenance therapy (LAMA, LABA, ICS).
57	Bronchiectasis	Two or more admissions with bronchiectasis exacerbations in last 12 months; No prophylactic azithromycin trialled in the 12 months prior to admission.	New
Genitourinary
58	Urinary retention	Prior diagnosis of benign prostatic hyperplasia OR bladder atony due to diabetes mellitus;	Original†
		Current use of a drug with anticholinergic effects or an opioid at the time of admission.
59	Recurrent urinary tract infection	No test for organism identification and sensitivity undertaken.	New
Sexually transmitted diseases
60	Chlamydia or gonorrhoea	Untreated with antibiotics for more than 1 week after results received.	New
Vaccine preventable diseases
61	Pneumonia	No pneumococcal vaccine if 'at risk' (chronic illness or>50 years);	New
		No revaccination after 5 years.
62	Influenza	No influenza vaccination in the past 12 months.	New
63	Tetanus	No/incomplete vaccination.	New
64	Diphtheria	No/incomplete vaccination.	New
65	Whooping cough	No/incomplete vaccination.	New
66	Acute poliomyelitis	No/incomplete vaccination.	New
67	Varicella	No/incomplete vaccination.	New
68	Measles	No/incomplete vaccination.	New
69	Rubella	No/incomplete vaccination.	New
70	Mumps	No/incomplete vaccination.	New
71	Hepatitis A	No/incomplete vaccination.	New
72	Hepatitis B	No/incomplete vaccination.	New
Other
73	Cellulitis	No treatment / inadequate treatment with antibiotics to treat staphylococcus aureus or streptococcus pyogenes with an appropriate antibiotic at time of admission.	New
74	Rheumatic fever (<21 years of age)	Prior diagnosis of rheumatic fever or rheumatic heart disease;	New
		No benzathine penicillin (or erythromycin if allergic) in the last 28 days.
75	Gout attack	Previous history of gout;	New
		Use of loop diuretics or thiazide diuretics.
76	Hepatitis C	No treatment with direct acting antivirals.	New
77	Methicillin resistant Staphylococcus aureus skin infection	Recurrent skin infection (>2 weeks);	New
		Continuing use of β-lactam antibiotic;
		No skin swab taken.
78	Jaw osteonecrosis	Use of a bisphosphonate or denosumab;	New
		No dental assessment within 6 months prior to admission.
79	Trachoma	Untreated with appropriate antibiotics.	New
80	Iron deficiency anaemia	Confirmed pregnancy;	New
		No FBE test during pregnancy.
81	Eclampsia	Prior diagnosis of hypertension (a systolic blood pressure of greater than or equal to 160 mm Hg or a diastolic blood pressure greater than or equal to 110 mm Hg) during the current pregnancy;	New
		No treatment with antihypertensive agent (suitable for use in pregnancy) at time of admission.

*The final list of clinical indicators has not been considered as part of any independent Health Technology Assessment (HTA) for effectiveness/cost-effectiveness.

†The original indicator (from Kalisch et al¹⁴) forms the basis of this indicator but it has been modified either to (i) update the indicator to reflect current guidelines or new medicines in the class; (ii) combine with another indictor/s for simplification or (iii) has been split into more indicators for clarity.

ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin II blockers; ARNi, angiotensin receptor-neprilysin inhibitors; ATC, anatomical therapeutic chemical; BUN, blood urea nitrogen; CHA2Ds2Vasc, congestive heart failure, hypertension, age, diabetes and stroke/TIA vascular disease (peripheral arterial disease, previous MI, aortic atheroma) (female gender is also included in this scoring system); CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; COX-2, cyclooxygenase-2; CRP, C-reactive protein; CVD, cardiovascular disease;DOAC, Direct oral anticoagulant; FBE, full blood examination; GI, gastrointestinal; HbA1c, glycolated haemoglobin; Hg, mercury; HMG-CoA, 3-hydroxy-3-methylglutaryl-CoA; HRT, hormone replacement therapy; ICS, inhaled corticosteroids;INR, international normalised ratio; LABA, long-acting beta agonists; LAMA, long-acting muscarinic antagonists; LMWH, low molecular weight heparin; MAOI, monoamine oxidase inhibitor; MI, myocardial infarction; MRSA, methicillin resistant Staphylococcus aureus; NSAID, non-steroidal anti-inflammatory drug; SABA, short-acting beta-2 agonists; SAMA, short-acting muscarinic antagonist; SIADH, syndrome of inappropriate antidiuretic hormone secretion; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressants; TIA, transient ischaemic attack.