Appropriate Use of Medications in Hospitals

Key Messages

• Efforts to improve medication prescribing practices in acute care hospitals represent an opportunity to prevent patient harms from unnecessary treatments and increase the use of effective therapies. However, the degree and impact of inappropriate medication use in acute care hospitals has not been well described in Canada because in-hospital prescribing data have not been readily accessible.
• In a first-of-its-kind analysis, the aim of this paper was to provide new, real-world evidence to better describe the magnitude of variation in the use of medications in acute care hospitals. Data analysis of approximately 535,000 hospitalizations across 115 hospitals in Ontario and Alberta through the VITAL research network identified substantial prescribing variation for each of the 4 key medication classes that were analyzed (antibiotics, antipsychotics, sedative-hypnotics [also referred to as sleep aids], and opioids). For example, sleep aid prescribing ranged from 12% to 81% of patients across hospitals. This is particularly striking, given recommendations against the routine use of these medications from the Canadian Society of Hospital Pharmacists, the Canadian Psychiatric Association, the Canadian Academy of Geriatric Psychiatry, and Choosing Wisely Canada, suggesting an opportunity to prevent harm from inappropriate use.
• Evidence-based interventions to safely reduce inappropriate prescribing already exist and have been effective in specific settings. Interventions typically involve changes to care protocols paired with practice feedback and/or clinical decision support. Examples include antibiotic stewardship programs that reduced extended-spectrum antibiotic use by 28%, and multicomponent initiatives that reduced sleep medication use by 15%.
• Electronic health records and hospital data-sharing networks now enable efficient measurement of in-hospital medication prescribing at a system-level scale for the first time in Canada. This creates an opportunity to identify targets for interventions, deliver point-of-care clinical decision support, and evaluate the effectiveness and safety of interventions across multiple sites.
• Policy-makers and hospital leaders can work together to establish networks that harness hospital electronic medical records systems to measure prescribing patterns, identify improvement opportunities, and implement quality improvement interventions. Systematically improving medication appropriateness across hospitals can help address both health care quality and financial sustainability in Canadian health care.