Reducing adverse events
=======================

* Alan J. Forster
* Carl van Walraven

The form to which William MacLean refers in his letter was being used during our study,1 and we commonly saw problems with how the forms were completed. For example, it was often difficult to distinguish old from new medications, poor handwriting often made prescriptions illegible, and only rarely was a contact number for the prescribing physician indicated on the form. Thus, although the forms probably have a role in guiding physicians, time pressures and other factors lead to unsafe prescribing practices. Because the form was used for almost all patients, we are unable to determine whether the risk of adverse events decreased with its use.

We support the idea of improving communication between multidisciplinary members of the health care team. MacLean highlights the changes in medication regimens that are often made during and after a hospital stay. Frequently, this information is not communicated effectively to patients,2 pharmacists or community physicians.3 The need to reconcile medication regimens before and after the hospital stay and the need to improve communications pertaining to medication use are obvious. However, translating these needs into practical, effective solutions will require substantially more investment than changes in paper forms. Although unproven, it is possible that better hospital information systems will be required, e.g., through computerized physician order entry4 or automated discharge summary generation.5 

**Alan J. Forster Carl van Walraven** The Ottawa Hospital The Ottawa Health Research Institute Ottawa, Ont.

## References

1.  1. Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. CMAJ 2004;170(3):345-9. 
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzAvMy8zNDUiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTcwLzExLzE2NTAuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Forster AJ, Bates DW, Gandhi T, Murff HJ, Peterson J. Adverse drug events following hospital discharge [abstract]. J Gen Intern Med 2003;18(Suppl 1):282. 
    
    

3.  3. van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. CMAJ 1995; 152(9):1437-42.
    
    [Abstract](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTUyLzkvMTQzNyI7czo0OiJhdG9tIjtzOjI0OiIvY21hai8xNzAvMTEvMTY1MC4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

4.  4. Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998;280(15):1311-6.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1001/jama.280.15.1311&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=9794308&link_type=MED&atom=%2Fcmaj%2F170%2F11%2F1650.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000076472500021&link_type=ISI) 

5.  5. van Walraven C, Laupacis A, Seth R, Wells G. Dictated versus database-generated discharge summaries: a randomized clinical trial. CMAJ 1999; 160(3):319-26. 
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjAvMy8zMTkiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTcwLzExLzE2NTAuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)