1
|
Nymoen LD, Pettersen JLS, Flatebø TE, Øie E, Viktil KK. Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population. Int J Clin Pharm 2024:10.1007/s11096-024-01760-8. [PMID: 38958864 DOI: 10.1007/s11096-024-01760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The process of identifying drug-related hospitalisations is subjective and time-consuming. Assessment tool for identifying hospital admissions related to medications (AT-HARM10) was developed to simplify and objectify this process. AT-HARM10 has not previously been externally validated, thus the predictive precision of the tool is uncertain. AIM To externally validate AT-HARM10 in adult patients admitted to the emergency department (ED). METHOD This retrospective cross-sectional study investigated 402 patients admitted to the ED, Diakonhjemmet Hospital, Oslo, Norway. A trained 5th-year pharmacy student used AT-HARM10 to assess all patients and to classify their ED visits as possibly or unlikely drug-related. Assessment of the same patients by an interdisciplinary expert panel acted as the gold standard. The external validation was conducted by comparing AT-HARM10 classifications with the gold standard. RESULTS According to AT-HARM10 assessments, 169 (42%) patients had a possible drug-related ED visit. Calculated sensitivity and specificity values were 95% and 71%, respectively. Further, positive and negative predictive values were 46% and 98%, respectively. Adverse effects/over-treatment and suboptimal treatment were the issues most frequently overestimated by AT-HARM10 compared with the gold standard. CONCLUSION AT-HARM10 identifies drug-related ED visits with high sensitivity. However, the low positive predictive value indicates that further review of ED visits classified as possible drug-related by AT-HARM10 is necessary. AT-HARM10 can serve as a useful first-step screening that efficiently identifies unlikely drug-related ED visits, thus only a smaller proportion of the patients need to be reviewed by an interdisciplinary expert panel.
Collapse
Affiliation(s)
| | | | | | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten K Viktil
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway.
- Department of Pharmacy, University of Oslo, Oslo, Norway.
| |
Collapse
|
2
|
Liu Y, Liu X, Xia B, Chen J, Sun W, Liu F, Cheng H. The application of Global Trigger Tool in monitoring antineoplastic adverse drug events: a retrospective study. Front Oncol 2024; 14:1230514. [PMID: 38779083 PMCID: PMC11109401 DOI: 10.3389/fonc.2024.1230514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aimed to establish an antineoplastic drugs trigger tool based on Global Trigger Tool (GTT), to examine the performance by detecting adverse drug events (ADEs) in patients with cancer in a Chinese hospital (a retrospective review), and to investigate the factors associating with the occurrence of antineoplastic ADEs. Methods Based on the triggers recommended by the GTT and those used in domestic and foreign studies and taking into account the scope of biochemical indexes in our hospital, some of them were adjusted. A total of 37 triggers were finally developed. Five hundred medical records of oncology patients discharged in our hospital from 1 June 2020 to 31 May 2021 were randomly selected according to the inclusion and exclusion criteria. These records were reviewed retrospectively by antineoplastic drugs trigger tool. The sensitivity and specificity of the triggers were analyzed, as well as the characteristics and risk factors for the occurrence of ADEs. Results Thirty-three of the 37 triggers had positive trigger, and the sensitivity rate was 91.8% (459/500). For the specificity, the positive predictive value of overall ADEs was 46.0% (715/1556), the detection rate of ADEs was 63.0% (315/500), the rate of ADEs per 100 admissions was 136.0 (95% CI, 124.1-147.9), and the rate of ADEs per 1,000 patient days was 208.33 (95% CI, 201.2-215.5). The top three antineoplastic drugs related to ADEs were antimetabolic drugs (29.1%), plant sources and derivatives (27.1%), and metal platinum drugs (26.3%). The hematologic system was most frequently involved (507 cases, 74.6%), followed by gastrointestinal system (89 cases, 13.1%). Multivariate logistic regression analysis showed that the number of combined drugs (OR = 1.14; 95% CI, 1.07-1.22; P < 0.001) and the previous history of adverse drug reaction (ADR) (OR = 0.38; 95% CI, 0.23-0.60; P < 0.001) were the risk factors for ADEs. The length of hospital stay (OR = 0.40; 95% CI, 0.14-1.12; P < 0.05) and the previous history of ADR (OR = 2.18; 95% CI, 1.07-4.45; P < 0.05) were the risk factors for serious adverse drug events (SAE). Conclusion The established trigger tool could be used to monitor antineoplastic drugs adverse events in patients with tumor effectively but still needs to be optimized. This study may provide some references for further research in order to improve the rationality and safety of antineoplastic medications.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Hua Cheng
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Russmann S, Martinelli F, Jakobs F, Pannu M, Niedrig DF, Burden AM, Kleber M, Béchir M. Identification of Medication Prescription Errors and Factors of Clinical Relevance in 314 Hospitalized Patients for Improved Multidimensional Clinical Decision Support Algorithms. J Clin Med 2023; 12:4920. [PMID: 37568322 PMCID: PMC10419486 DOI: 10.3390/jcm12154920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Potential medication errors and related adverse drug events (ADE) pose major challenges in clinical medicine. Clinical decision support systems (CDSSs) help identify preventable prescription errors leading to ADEs but are typically characterized by high sensitivity and low specificity, resulting in poor acceptance and alert-overriding. With this cross-sectional study we aimed to analyze CDSS performance, and to identify factors that may increase CDSS specificity. Clinical pharmacology services evaluated current pharmacotherapy of 314 patients during hospitalization across three units of two Swiss tertiary care hospitals. We used two CDSSs (pharmaVISTA and MediQ), primarily for the evaluation of drug-drug interactions (DDI). Additionally, we evaluated potential drug-disease, drug-age, drug-food, and drug-gene interactions. Recommendations for change of therapy were forwarded without delay to treating physicians. Among 314 patients, automated analyses by both CDSSs produced an average of 15.5 alerts per patient. In contrast, additional expert evaluation resulted in only 0.8 recommendations per patient to change pharmacotherapy. For clinical pharmacology experts, co-factors such as comorbidities and laboratory results were decisive for the classification of CDSS alerts as clinically relevant in individual patients in about 70% of all decisions. Such co-factors should therefore be used for the development of multidimensional CDSS alert algorithms with improved specificity. In combination with local expert services, this poses a promising approach to improve drug safety in clinical practice.
Collapse
Affiliation(s)
- Stefan Russmann
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
- Drugsafety.ch, Seestrasse 221, 8703 Küsnacht, Switzerland;
- Department of Internal Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
- Center for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland
| | - Fabiana Martinelli
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Franziska Jakobs
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Manjinder Pannu
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
| | - David F. Niedrig
- Drugsafety.ch, Seestrasse 221, 8703 Küsnacht, Switzerland;
- Hospital Pharmacy, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland
| | - Andrea Michelle Burden
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Martina Kleber
- Department of Internal Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Markus Béchir
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
- Center for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland
| |
Collapse
|
4
|
Dahmke H, Fiumefreddo R, Schuetz P, De Iaco R, Zaugg C. Tackling alert fatigue with a semi-automated clinical decision support system: quantitative evaluation and end-user survey. Swiss Med Wkly 2023; 153:40082. [PMID: 37454289 DOI: 10.57187/smw.2023.40082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
STUDY AIMS Clinical decision support systems (CDSS) embedded in hospital electronic health records efficiently reduce medication errors, but there is a risk of low physician adherence due to alert fatigue. At the Cantonal Hospital Aarau, a CDSS is being developed that allows the highly accurate detection and correction of medication errors. The semi-automated CDSS sends its alerts either directly to the physician or to a clinical pharmacist for review first. Our aim was to evaluate the performance of the recently implemented CDSS in terms of acceptance rate and alert burden, as well as physicians' satisfaction with the CDSS. METHODS All alerts generated by the clinical decision support systems between January and December 2021 were included in a retrospective quantitative evaluation. A team of clinical pharmacists performed a follow-up to determine whether the recommendation made by the CDSS was implemented by the physician. The acceptance rate was calculated including all alerts for which it was possible to determine an outcome. A web-based survey was conducted amongst physicians to assess their attitude towards the CDSS. The survey questions included overall satisfaction, helpfulness of individual algorithms, and perceived alert burden. RESULTS In 2021, a total of 10,556 alerts were generated, of which 619 triggered a direct notification to the physician and 2,231 notifications were send to the physician after evaluation by a clinical pharmacist. The acceptance rates were 89.8% and 68.4%, respectively, which translates as an overall acceptance rate of 72.4%. On average, clinical pharmacists received 17.2 alerts per day, while all of the hospital physicians together received 7.8 notifications per day. In the survey, 94.5% of physicians reported being satisfied or very satisfied with the CDSS. Algorithms addressing potential medication errors concerning anticoagulants received the highest usefulness ratings. CONCLUSION The development of this semi-automated clinical decision support system with context-based algorithms resulted in alerts with a high acceptance rate. Involving clinical pharmacists proved a promising approach to limit the alert burden of physicians and thus tackle alert fatigue. The CDSS is well accepted by our physicians.
Collapse
Affiliation(s)
- Hendrike Dahmke
- Hospital Pharmacy, Kantonsspital Aarau, Aarau, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Rico Fiumefreddo
- Department of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Department of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Claudia Zaugg
- Hospital Pharmacy, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
5
|
Convertino I, Lorenzoni V, Gini R, Turchetti G, Fini E, Giometto S, Bartolini C, Paoletti O, Ferraro S, Cappello E, Valdiserra G, Bonaso M, Blandizzi C, Tuccori M, Lucenteforte E. Drug-Utilization, Healthcare Facilities Accesses and Costs of the First Generation of JAK Inhibitors in Rheumatoid Arthritis. Pharmaceuticals (Basel) 2023; 16:ph16030465. [PMID: 36986565 PMCID: PMC10058541 DOI: 10.3390/ph16030465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
This study is aimed at describing tofacitinib and baricitinib users by characterizing their prescription and healthcare histories, drug and healthcare utilization patterns, and direct costs from a healthcare system perspective. This retrospective cohort study was performed using Tuscan administrative healthcare databases, which selected two groups of Janus kinase inhibitors (JAKi) incident users (index date) from 1st January 2018 to 31 December 2019 and from 1 January 2018 to 30 June 2019. We included patients ≥18 years old, at least 10 years of data, and six months of follow-up. In the first analysis, we describe mean time, standard deviation (SD), from the first-ever disease-modifying antirheumatic drug (DMARD) to the JAKi, and costs of healthcare facilities and drugs in the 5 years preceding the index date. In the second analysis, we assessed Emergency Department (ED) accesses and hospitalizations for any causes, visits, and costs in the follow-up. In the first analysis, 363 incident JAKi users were included (mean age 61.5, SD 13.6; females 80.7%, baricitinib 78.5%, tofacitinib 21.5%). The time to the first JAKi was 7.2 years (SD 3.3). The mean costs from the fifth to the second year before JAKi increased from 4325 € (0; 24,265) to 5259 € (0; 41,630) per patient/year, driven by hospitalizations. We included 221 incident JAKi users in the second analysis. We observed 109 ED accesses, 39 hospitalizations, and 64 visits. Injury and poisoning (18.3%) and skin (13.8%) caused ED accesses, and cardiovascular (69.2%) and musculoskeletal (64.1%) caused hospitalizations. The mean costs were 4819 € (607.5; 50,493) per patient, mostly due to JAKi. In conclusion, the JAKi introduction in therapy occurred in compliance with RA guidelines and the increase in costs observed could be due to a possible selective prescription.
Collapse
Affiliation(s)
- Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Rosa Gini
- Tuscan Regional Healthcare Agency, 50100 Florence, Italy
| | | | - Elisabetta Fini
- Medical Specialization School of Pharmacology, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Olga Paoletti
- Tuscan Regional Healthcare Agency, 50100 Florence, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, 56126 Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
6
|
Lan T, Wang H, Li X, Yin H, Shao D, Jiang Y, Yu Q. The effect of clinical pharmacists' intervention in adverse drug reaction reporting: a retrospective analysis with a 9-year interrupted time series. BMC Health Serv Res 2022; 22:925. [PMID: 35854263 PMCID: PMC9295299 DOI: 10.1186/s12913-022-08320-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background In China, 85.4% of adverse drug reactions (ADRs) are spontaneously reported by healthcare facilities. As a result, many ADRs are not reported due to lack of mandatory reporting requirements. As healthcare professionals, clinical pharmacists (CPhs) serve as a bridge between clinical work and medication and ensure rational drug use. In China, A team of CPhs implemented an intervention for ADRs reporting, with the goal of improving the number of ADRs reports, the number of unreported ADRs, and the standardized reporting rate. Methods On June 01, 2015, a team of CPhs implemented an intervention for ADRs reporting at a Grade A, Class 3 hospital in China. The drug review catalogue (DRC) was used to screen physician orders for having visible symptoms of ADRs across departments, pooled the ADRs, and submitted them to the Center for Advanced Drug Monitoring (CNCAM). We retrospectively analysed the effect of a CPhs ADRs reporting intervention on the number of clinical ADRs reports, the number of unreported ADRs, and the standardized reporting rate over a 9-year period by interrupted time series (ITS). The method was implemented at the hospital on June 1, 2015, and a segmented regression model was used to analyse the data from January 1, 2010, to December 31, 2019. Results After the CPhs ADRs reporting intervention, the number of inpatient ADRs reports submitted to the CNCAM immediately increased by approximately 63 (62.658, P < 0.01) and then decreased by approximately 1 (0.701, P = 0.000151 < 0.01) per month afterward; the number of unreported ADRs was immediately reduced by approximately 44 (44.091, P < 0.01) and remained largely unchanged over time (P > 0.05); the standardized ADRs reporting rate per month immediately increased by 63.634% (P < 0.01) and remained largely unchanged over time (P > 0.05). Conclusion The CPhs ADRs reporting intervention had an immediate effect on improving ADRs reporting, which highlights the severity of ADRs underreporting in Chinese hospitals. The method is practical and should be used more widely in clinical practice. For example, the method can adjust and establish a DRC catalog that meets the actual situation of the implementing hospital based on the hospital's drug use habits and has the characteristics of good adaptability. However, it does have some limitations; for example, it may be difficult to detect early ADRs without visible symptoms.
Collapse
Affiliation(s)
- Tianwei Lan
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hua Wang
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xin Li
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hang Yin
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dan Shao
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yueyao Jiang
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qian Yu
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, China.
| |
Collapse
|
7
|
Sahilu T, Getachew M, Melaku T, Sheleme T. Adverse Drug Events and Contributing Factors Among Hospitalized Adult Patients at Jimma Medical Center, Southwest Ethiopia: A Prospective Observational Study. Curr Ther Res Clin Exp 2020; 93:100611. [PMID: 33296443 PMCID: PMC7689274 DOI: 10.1016/j.curtheres.2020.100611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background Adverse drug events (ADEs) are common complications of clinical care resulting in significant morbidity, mortality, and high clinical expenditure. Population-level estimates of inpatient ADEs are limited in Ethiopia. Objective This study aimed to assess the incidence, contributing factors, severity, and preventability of ADEs among hospitalized adult patients at Jimma Medical Center, Ethiopia. Methods A prospective observational study design was conducted among hospitalized adult patients at tertiary hospital in Ethiopia. A structured data collection tool was prepared from relevant literatures for data collection. Data were analyzed using statistical software. Logistic regression was performed to identify factors contributing to ADE occurrence. P values < 0.05 were considered statistically significant. Results A total of 319 patients were included with follow-up period of 5667 person-days. About 50.5% were women. The mean (SD) age of patients was 43 (17.6) years. One hundred sixteen ADEs were identified with the incidence of 36.4 (95% CI, 30.1-43.6) per 100 admissions and 20.5 (95% CI, 16.9-24.6) per 1000 person-days. Antituberculosis agents (adjusted odds ratio [aOR] = 2.52; 95% CI, 1.06-5.98; P = 0.036), disease of the circulatory system (aOR = 2.67; 95% CI, 1.46-4.89; P = 0.001), disease of the digestive system (aOR = 2.84; 95% CI, 1.45-5.57; P = 0.002), being on medication during admission (aOR = 3.09; 95% CI, 1.77-5.41; P < 0.001), and hospital stay more than 2 weeks (aOR = 3.93; 95% CI, 1.39-11.12; P = 0.010) were independent predictors of ADE occurrence. Conclusions One in every 4 patients admitted to the hospital experienced ADEs during their hospital stay. Most ADEs were moderate in severity. About two-thirds of the ADEs identified were deemed probably or definitely preventable. Therefore, it is high time to reinforce large-scale efforts to redesign safer, higher quality health care systems to adequately tackle the problem.
Collapse
Affiliation(s)
- Tamiru Sahilu
- Department of Pharmacy, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Mestawet Getachew
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tadesse Sheleme
- Department of Pharmacy, College of Public Health and Medical Science, Mettu University, Metu Zuria, Ethiopia
| |
Collapse
|