Factors associated with preventable adverse drug reactions.

Factors associated with preventable adverse drug reactions (ADRs) in a community hospital patient population were studied. The following data were collected by concurrent review of all ADRs reported from July 1992 through January 1993: patient demographics, ADR variables, length of stay, and preventability of ADR. These data were analyzed to determine factors associated with preventable ADRs. Of the 203 ADRs reported, 38 (19%) were identified as preventable. The only significant difference found between preventable and nonpreventable ADRs was in severity (preventable ADRs were more severe). Length of stay (LOS) for patients who experienced ADRs was longer than the national average for patients in the same diagnosis-related group. Most of the preventable ADRs involved (1) a documented allergy to medication ordered or to similar medications, (2) anticoagulants or thrombolytics, (3) that required serum drug concentration monitoring (in the absence of pharmacokinetics service involvement), and (4) renally eliminated drugs for which dosage adjustments were not made in patients with impaired renal function. Strategies for minimizing ADRs were developed based on these factors. An ADR reporting program helped in identifying preventable ADRs, determining factors associated with preventable ADRs, and developing strategies for preventing ADRs in a community hospital patient population.