Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Drug losses and theft from the healthcare system are accelerating; hospitals are pressured to implement safeguards to prevent drug diversion. Thus far, no reviews summarize all known risks and potential safeguards for hospital diversion. Past incidents of hospital drug diversion have impacted patient and staff safety, increased hospital costs, and resulted in infectious disease outbreaks. ⋯ Careful configuration of healthcare technologies and processes in the hospital environment can reduce the opportunity for diversion. These system-based strategies broaden the response to diversion beyond that of individual accountability. Further evidence is urgently needed to address the vulnerabilities outlined in this review and prevent harm.
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We compared prevalence estimates and prognostication if frailty were defined using the face-to-face Clinical Frailty Scale (CFS) or the administrative-data-derived Hospital Frailty Risk Score (HFRS). We evaluated 489 adults from a prospective cohort study of medical patients being discharged back to the community; 276 (56%) were deemed frail (214 [44%] on the HFRS and 161 [33%] on the CFS), but only 99 (20%) met both frailty definitions (kappa 0.24, 95% CI 0.16-0.33). Patients classified as frail on the CFS exhibited significantly higher 30-day readmission/death rates, 19% versus 10% for those not frail (aOR [adjusted odds ratio] 2.53, 95% CI 1.40-4.57) and 21% versus 6% for those aged >65 years (aOR 4.31, 95% CI 1.80-10.31). Patients with HFRS-defined frailty exhibited higher 30-day readmission/death rates that were not statistically significant (16% vs 11%, aOR 1.62 [95% CI 0.95-2.75] in all adults and 14% vs 11%, aOR 1.24 [95% CI 0.58-2.83] in those aged >65 years).