Corinne M Hohl1, Stephanie A Woo2, Amber Cragg2, Maeve E Wickham2, Christine Ackerley2, Frank Scheuermeyer2, Diane Villanyi2. 1. Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC chohl@mail.ubc.ca. 2. Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC.
Abstract
BACKGROUND: Adverse drug events are an important cause of preventable emergency department visits and hospital admissions. We examined repeat adverse drug events associated with outpatient medications resulting in acute care utilization. METHODS: This descriptive analysis combined data from 3 prospective multicentre observational studies, in which clinical pharmacists and physicians independently evaluated patients who visited the emergency department for adverse drug events in 3 hospitals in British Columbia. During these studies, an independent committee adjudicated all discordant and uncertain cases using a standardized algorithm. For the current study, we retrospectively reviewed the medical and research records of all patients 19 years of age and older who had been diagnosed with an adverse drug event during the primary studies to determine the proportion of repeat events. We used multivariable logistic regression to identify factors associated with repeat events; we adjusted for clustering at the hospital level for patient-level analyses and at the patient level for event-level analyses. RESULTS: Among 12 977 patients, 1178 were diagnosed with 1296 adverse drug events at the point of care. Of these events, 32.5% (421 of 1296; 95% confidence interval [CI] 29.8%-35.1%) were repeat events, of which 75.3% (317 of 421; 95% CI 71.1%-79.5%) were deemed probably or definitely preventable as re-exposure to the culprit medication or repeat withdrawal of an indicated medication was inconsistent with best medical practice. Patients presenting with repeat events were more likely to have renal failure (odds ratio [OR] 2.01; 95% CI 1.32%-3.07%) or a mental health diagnosis (OR 1.39; 95% CI 1.02%-1.88%). INTERPRETATION: A high proportion of adverse drug events were repeat events, most of which were deemed preventable. Interventions to ensure that care providers are aware of previously diagnosed adverse drug events when prescribing or dispensing need to be developed and evaluated and may reduce unintentional re-exposures to previously harmful medications. Copyright 2019, Joule Inc. or its licensors.
BACKGROUND: Adverse drug events are an important cause of preventable emergency department visits and hospital admissions. We examined repeat adverse drug events associated with outpatient medications resulting in acute care utilization. METHODS: This descriptive analysis combined data from 3 prospective multicentre observational studies, in which clinical pharmacists and physicians independently evaluated patients who visited the emergency department for adverse drug events in 3 hospitals in British Columbia. During these studies, an independent committee adjudicated all discordant and uncertain cases using a standardized algorithm. For the current study, we retrospectively reviewed the medical and research records of all patients 19 years of age and older who had been diagnosed with an adverse drug event during the primary studies to determine the proportion of repeat events. We used multivariable logistic regression to identify factors associated with repeat events; we adjusted for clustering at the hospital level for patient-level analyses and at the patient level for event-level analyses. RESULTS: Among 12 977 patients, 1178 were diagnosed with 1296 adverse drug events at the point of care. Of these events, 32.5% (421 of 1296; 95% confidence interval [CI] 29.8%-35.1%) were repeat events, of which 75.3% (317 of 421; 95% CI 71.1%-79.5%) were deemed probably or definitely preventable as re-exposure to the culprit medication or repeat withdrawal of an indicated medication was inconsistent with best medical practice. Patients presenting with repeat events were more likely to have renal failure (odds ratio [OR] 2.01; 95% CI 1.32%-3.07%) or a mental health diagnosis (OR 1.39; 95% CI 1.02%-1.88%). INTERPRETATION: A high proportion of adverse drug events were repeat events, most of which were deemed preventable. Interventions to ensure that care providers are aware of previously diagnosed adverse drug events when prescribing or dispensing need to be developed and evaluated and may reduce unintentional re-exposures to previously harmful medications. Copyright 2019, Joule Inc. or its licensors.
Authors: Erina Chan; Serena S Small; Maeve E Wickham; Vicki Cheng; Ellen Balka; Corinne M Hohl Journal: J Med Internet Res Date: 2021-12-10 Impact factor: 5.428