Table 5.
Potential risk factors and protective factors for drug-related problems
| DRP | Category of factors | Potential risk factors | Potential protective factors | |
|---|---|---|---|---|
| a. | Potentially inappropriate medications | Patient related | Length of hospitalisation [47, 49] | Increased age [47, 50] |
| Female [44] | Dementia diagnosis [50] | |||
| Cognitive impairment [43, 44] | ||||
| Fall ≥1 in the preceding 3 months [43, 44] | ||||
| Hospitalisation ≥1 in the preceding year [43] | ||||
| Living in an institution [43] | ||||
| Psychiatric disorder [44] | ||||
| Decreased personal care activities [46] | ||||
| Clinical global impression at admission [47, 49] | ||||
| F1, F2 and F3 diagnosis [49] | ||||
| Schizophrenia [50] | ||||
| Substance abuse [50] | ||||
| Medication related | Increased number of medications [43, 45, 47, 48, 50] | |||
| Potentially inappropriate omissions | Patient related | Female [44] | ||
| Cognitive disorder [44] | ||||
| Psychiatric disorder [43, 44] | ||||
| Charlson Comorbidity Index [43–45] | ||||
| Living in an institution [43] | ||||
| Increased number of medications [44] | ||||
| b. | Adverse drug reactions | Medication related | Increased number of drugs [50] | |
| Neuroleptics [17] | ||||
| Antidepressants [17] | ||||
| Diuretics [17] | ||||
| Angiotensin-converting enzyme inhibitors/angiotensin 2 receptor blockers [17] | ||||
| Anti-dementia agents [17] | ||||
| Type I, III or IV anti-arrhythmic agents [17] | ||||
| Potentially inappropriate medications [50] | ||||
| Adverse drug events | Patient-related | Length of hospitalisation [4] | ||
| c. | Medication discrepancies | Patient related | Age [58] | |
| Medication related | Number of medications [58] | |||
| Hospital related | Gap (days) between admission and medication reconciliation [58] | |||
| d. | Drug related problems | Patient related | Age [59] | |
| Medication related | Number of medications [59, 60] | |||
| e. | Medication errors | Hospital related | Preparation of the medication by nurses immediately before administration in the care setting (compared with preparing medications at night for the following day) [51] | |
| f. | Prescribing errors | Patient related | Somatic diagnosis [55] | |
| Medication related | Non-psychotropic medications [52] | |||
| Number of prescribed items [53, 55] | ||||
| Hospital related | Specialty trainee prescriber [53, 54] | Rewritten items [54] | ||
| Staff grade psychiatrist prescriber [53, 54] | Discharge items [54] | |||
| General practitioner speciality trainee prescribers [53] | ||||
| Core medical trainee prescribers [53] | ||||
| Consultant prescribers [53] | ||||
| Unknown/locum prescribers [53] | ||||
| Electronic discharge pro forma [53] | ||||
| Clinically relevant prescribing errors: | ||||
| Specialty trainee prescriber [54] | ||||
| Consultant psychiatrist prescriber [54] [53] | ||||
| Staff grade [53] | ||||
| Unknown/locum prescribers [53] | ||||
| Prescriptions at admission [54] | ||||
| Discharge prescriptions [54] | ||||
| Re-written items [54] | ||||
| Medication administration errors | Patient related | Diagnosis of organic brain disease [20] | ||
| Lacking capacity to consent to medication administration [20] | ||||
| Swallowing difficulties [20] | ||||
| Regularly spitting out or refusing medication [20] | ||||
| Medication related | Non-oral route medications [20] | |||
| Non-psychotropic medications [20] | ||||
| Hospital related | Administering nurse being required to carry out other duties during the medication round [21] | Administering medication at 22.00 hours medication round [20] | ||
| Number of ‘when required’ doses given at the medication round time [21] | ||||
| Number of patients on the ward at the medication round time [21] | ||||
| Number of regular doses to be administered in the round [21] |