The complexities of managing medications for patients discharged from hospitals to skilled nursing facilities (SNFs) were recently reviewed in two separate studies.  Specifically, the research groups studied the prevalence of high-dose pain medications and potentially inappropriate medications (PIM) prescribed to patients at discharge to these settings.

A University of Oregon study found that 70% of hospitalized patients discharged to skilled care were prescribed opioids, 68% of whom received orders for oxycodone.  Among the 4,300 study participants who received opioid prescriptions, 61% were age 65 and older.

More than half of the opioid prescriptions in the study had a daily morphine milligram equivalent of 90 and higher―increasing the risk for opioid-related harm, the study found.

This scenario describes significant challenges for skilled care. Caregivers must look for and manage opioid-related risks in addition to interactions with multiple drugs and the inherent risks associated with frailty and cognitive impairment. Ironically, skilled nursing facility residents are often undertreated for pain.

A second study evaluated the impact of PIM prescribed at discharge on subsequent adverse events 30 days after hospitalization.  Two out of every three post-surgery patients over the age of 65 (66%) were prescribed PIMs at discharge. In the 30 days after discharge, 36% visited the emergency department, were hospitalized, or died. Almost one in 10 experienced an adverse drug event.

These studies clearly demonstrate the need for careful review of drug regimens after hospital discharge, particularly for those 65 and over. Fortunately, SNFs can easily address this challenge by requesting review of admission orders from their contracted long-term care pharmacy, which can be provided in addition to ongoing, regularly scheduled Medication Regimen Reviews.

Problems associated with hospital-discharge medications, however, may also impact assisted and supportive living, where resident acuity is often similar to that of nursing homes and SNFs. Operators may wish to consider how post-hospital discharge or ongoing Medication Regimen Reviews can potentially prevent medication-related rehospitalization and reduce the liability risk for communities.

The University of Oregon study was published in Pharmacoepidemiology and Drug Safety and can be found here.
The PIM study was published in the Journal of the American Geriatrics Society and can be found here.