The first patients to visit Amsterdam UMC's "post-covid-19 outpatient clinic" in 2020 taught doctors and pharmacists an important lesson: in times of a crisis, information about medication can easily be jeopardized. "This is a valuable lesson for the crises that are doubtless still to come."


Working in hospitals, especially in the first months of the corona crisis, was occasionally stressful and maynot come as a surprise. The crisis policy was aimed at keeping care manageable and providing enough protective materials for healthcare providers. And that only barely succeeded in the first few months. "We got the impression, early on in the COVID-19 crisis, that the standard of care of reconcilliating medication use with the patient on hospital admission was no longer feasable," says pharmacist and clinical pharmacologist in training Mahomedradja. "In addition, our Pharmacotherapy team, a specialized team of medical doctors and pharmacists dedicated to improve in-hospital safe prescribing, was hardly allowed to visit clinical wards anymore due to safety reasons."

Together with internist - clinical pharmacologist Van den Beukel, then deputy chairman of the Pharmacotherapy Team, Mahomedradja decided to set up projects to analyze covid-19 patients’ medication and promote medication safety in the first months of the corona crisis. One of these was this project at the post-covid-19 outpatient clinic.

Poorly regulated blood pressure

Among the first 98 patients who visited the post-covid-19 outpatient clinic three months after hospital discharge, prescribing errors were indeed found. Mahomedradja: "One of the cases - fortunately one of only a few - concerned a patient who was prescribed medication for hypertension during admission. But on discharge the dosage was not adjusted. Three months later, during the check-up at the post-covid clinic, this patient was found to be dizzy when standing up, due to low blood pressure."

"Fortunately, this did not cause any irreparable problems", Van den Beukel emphasizes. "But it does show how easily things can go wrong. There were many changes on the wards, of doctors but also of patients. In addition, the general practitioners were also under pressure. The correct transfer of information regarding medication sometimes fell by the wayside."

Vulnerable position

The publication about the prescribing errors did not come about without a struggle, the authors say. "Two journals rejected the paper because all included patients included in the study were treated in one hospital", Van den Beukel says. "Statistically, that is indeed a weak basis, but we still felt it was very important to share these results with colleagues, both nationally and internationally. We believe that our hospital was certainly not unique in this time of crisis. Patients were transferred to us from all over The Netherlands. We suspect that this prescribing errors was made in other hospitals as well, but we have not been able to investigate that."

"Of course we are aware that we are making ourselves vulnerable with this publication. We are actually telling the outside world: this could have been done better. But we want to guard against this being framed as 'bad care.' Apart from that, evaluating care, especially in times of an healthcare crisis, is part of your duty of care. Or as the famous American lawyer Mark McCormack once put it: 'A crisis situation has two phases: in the first phase you manage the crisis and in the second you learn from it. Success is achieved only after you have done both'."

Pressure off

Meanwhile, Amsterdam UMC's post-covid-19 outpatient clinic is being phased out, says pulmonologist Kalverda. "The pressure is off at the moment. The majority of ex-covid patients recover well and do not need to be seen again separately. The old safety nets within healthcare are back, including medication verification on hospital admission and the important primary care provided by GP’s. Because these were also under heavy pressure," Kalverda knows. "And unlike at the beginning of the crisis, when only the direct caregivers were allowed to visit a patient, the Pharmacotherapy team is also allowed to visit wards again."

"That 'Pharmacotherapy team' is unique in Amsterdam UMC," Mahomedradja emphasizes. "It has clearly proven its usefulness. In addition, it has proven to be important, especially in a crisis situation, to keep various safety systems intact within healthcare and specifically in the hospital. That is the message of our publication." Almost in the way Johan Cruijff used to say, Mahomedradja adds: “You only see it when you know it!"

Text: Rob Buiter
Photo: Shutterstock