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Pradhan P, Lavallee M, Akinola S, Escobar Gimenes FR, Berard A, Methot J, Piche ME, Gonella JM, Cloutier L, Leclerc J. Causality assessment of adverse drug reaction: A narrative review to find the most exhaustive and easy-to-use tool in post-authorization settings. J Appl Biomed 2023; 21:59-66. [PMID: 37376882 DOI: 10.32725/jab.2023.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The core motive of pharmacovigilance is the detection and prevention of adverse drug reactions (ADRs), to improve the risk-benefit balance of the drug. However, the causality assessment of ADRs remains a major challenge among clinicians, and none of the available tools of causality assessment used for assessing ADRs have been universally accepted. OBJECTIVE To provide an up-to-date overview of the different causality assessment tools. METHODS We conducted electronic searches in MEDLINE, EMBASE, and the Cochrane database. The eligibility of each tool was screened by three reviewers. Each eligible tool was then scrutinized for its domains (the reported specific set of questions/areas used for calculating the likelihood of cause-and-effect relation of an ADR) to discover the most comprehensive tool. Finally, we subjectively assessed the tool's ease-of-use in a Canadian, Indian, Hungarian, and Brazilian clinical context. RESULTS Twenty-one eligible causality assessment tools were retrieved. Naranjo's tool and De Boer's tool appeared the most comprehensive among all the tools, covering 10 domains each. Regarding "ease-of-use" in a clinical setting, we judged that many tools were hard to implement in a clinical context because of their complexity and/or lengthiness. Naranjo's tool, Jones's tool, Danan and Benichou's tool, and Hsu and Stoll's tool appeared to be the easiest to implement into various clinical contexts. CONCLUSION Among the many tools identified, 1981 Naranjo's scale remains the most comprehensive and easy to use for performing causality assessment of ADRs. Upcoming analysis should compare the performance of each ADR tool in clinical settings.
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Affiliation(s)
- Pallavi Pradhan
- University of Quebec at Trois-Rivieres, Department of Anatomy, Trois-Rivieres, Canada
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
| | - Maude Lavallee
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
| | - Samuel Akinola
- University of Pecs, Faculty of Health Sciences, Department of Nursing, Pecs, Hungary
| | | | - Anick Berard
- University Hospital Center, Research Center of Sainte-Justine, Montreal, Canada
- University of Montreal, Faculty of Pharmacy, Montreal, Canada
| | - Julie Methot
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
| | - Marie-Eve Piche
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Medicine, Laval, Canada
| | | | - Lyne Cloutier
- University of Quebec at Trois-Rivieres, Department of Nursing, Trois-Rivieres, Canada
| | - Jacinthe Leclerc
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
- University of Quebec at Trois-Rivieres, Department of Nursing, Trois-Rivieres, Canada
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Park S, Kim AJ, Ah YM, Lee MY, Lee YJ, Chae J, Rho JH, Kim DS, Lee JY. Prevalence and predictors of medication-related emergency department visit in older adults: A multicenter study linking national claim database and hospital medical records. Front Pharmacol 2022; 13:1009485. [PMID: 36313329 PMCID: PMC9614024 DOI: 10.3389/fphar.2022.1009485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Older adults are more likely to experience drug-related problems (DRP), which could lead to medication-related emergency department visits (MRED). To properly evaluate MRED, the entire history of drug use should be evaluated in a structured manner. However, limited studies have identified MRED with complete prescription records. We aimed to evaluate the prevalence and risk factors of MRED among community-dwelling older patients by linking national claims data and electronic medical records using a standardized medication related admission identification method.Methods: We included older patients who visited the emergency departments of four participating hospitals in 2019. Among the 54,034 emergency department (ED) visitors, we randomly selected 6,000 patients and structurally reviewed their medical records using a standardized MRED identification method after linking national claims data and electronic medical records. We defined and categorized MRED as ED visits associated with adverse drug events and those caused by the underuse of medication, including treatment omission and noncompliance and assessed as having probable or higher causality. We assessed preventability using Schumock and Thornton criteria.Results: MRED was observed in 14.3% of ED visits, of which 76% were preventable. In addition, 32.5% of MRED cases were related to underuse or noncompliance, and the rest were related to adverse drug events. Use of antipsychotics, benzodiazepines, anticoagulants, traditional nonsteroidal anti-inflammatory drugs without the use of proton pump inhibitors, P2Y12 inhibitors, insulin, diuretics, and multiple strong anticholinergic drugs were identified as predictors of MRED.Conclusion: One in seven cases of ED visits by older adults were medication related and over three-quarters of them were preventable. These findings suggest that DRPs need to be systemically screened and intervened in older adults who visit ED.
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Affiliation(s)
- Soyoung Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - A Jeong Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, South Korea
| | - Mee Yeon Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
- Department of Pharmacy, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Yu Jeong Lee
- Department of Pharmacy, Pusan National University Hospital, Busan, South Korea
| | - Jungmi Chae
- Department of Research, Health Insurance Review and Assessment Service, Chuncheon, South Korea
| | - Ju Hyun Rho
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Sook Kim
- Department of Research, Health Insurance Review and Assessment Service, Chuncheon, South Korea
- *Correspondence: Dong-Sook Kim, ; Ju-Yeun Lee,
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
- *Correspondence: Dong-Sook Kim, ; Ju-Yeun Lee,
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Abstract
OBJECTIVE Our objective was to determine the extent surgical disciplines categorize, define, and study errors, then use this information to provide recommendations for both current practice and future study. SUMMARY BACKGROUND DATA The report "To Err is Human" brought the ubiquity of medical errors to public attention. Variability in subsequent literature suggests the true prevalence of error remains unknown. METHODS In January 2020, PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Only studies with Oxford Level of Evidence Level 3 or higher were included. RESULTS Of 3,064 studies, 92 met inclusion criteria: 6 randomized controlled trials, 4 systematic reviews, 24 cohort, 10 before-after, 35 outcome/audit, 5 cross sectional and 8 case-control studies. Over 15,933,430 patients and 162,113 errors were represented. There were 6 broad error categories, 13 different definitions of error, and 14 study methods. CONCLUSIONS Reported prevalence of error varied widely due to a lack of standardized categorization, definitions, and study methods. Future research should focus on immediately recognizing errors to minimize harm.
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Lönnbro J, Holmqvist L, Persson E, Thysell P, Åberg ND, Wallerstedt SM. Inter-rater reliability of assessments regarding the quality of drug treatment, and drug-related hospital admissions. Br J Clin Pharmacol 2021; 87:3825-3834. [PMID: 33609324 DOI: 10.1111/bcp.14790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS To investigate inter-rater agreement on the quality of drug treatment, and the relationship between the drug treatment and hospital admission. METHODS Three specialist physicians and two resident physicians determined, independently and in consensus, the quality of drug treatment from an overall medical perspective, and its association with admission, in 30 randomly selected patients (50% female, median age 72 years) admitted to Sahlgrenska University Hospital, Sweden, in April 2018. The inter-rater agreement was evaluated with Gwet's agreement coefficient (AC1 ). RESULTS In all, 200 (95%) out of 210 drugs at admission and 238 (97%) out of 245 drugs at discharge were assessed as reasonable drug treatment by all assessors. Conversely, none of the drugs at admission, and two at discharge, were assessed as unreasonable drug treatment by all assessors (AC1 : 0.88 and 0.94 [all], 0.86 and 0.95 [specialists], 0.92 and 0.92 [residents], respectively). The assessments regarding the association between the drug treatment and the hospital admission (not related or main/contributory reason) were consistent between the assessors for 16 out of 30 patients (AC1 : 0.67 [all], 0.74 [specialists], 0.54 [residents]). In none of the three cases where the hospital admission was considered possibly attributable to a prescribing error did the assessors make consistent assessments. CONCLUSIONS As the inter-rater agreement ranged between weak and almost perfect, the reliability of assessments of drug treatment quality, as well as adverse consequences, appears to be a methodological concern. To yield acceptably reliable results regarding both drug treatment aspects at issue, specialist physicians should be involved.
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Affiliation(s)
- Johan Lönnbro
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lina Holmqvist
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Persson
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Thysell
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - N David Åberg
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,HTA Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Tran T, Johnson DF, Balassone J, Tanner F, Chan V, Garrett K. Effect of an integrated clinical pharmacy service with the general medical units on patient flow and medical staff satisfaction: a pre‐ and postintervention study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Tim Tran
- Pharmacy Department Austin Health Melbourne Australia
- Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Douglas Forsyth Johnson
- Department of General Medicine Austin Health Melbourne Australia
- Department of Medicine Austin Health The University of Melbourne Melbourne Australia
| | | | | | - Vincent Chan
- Pharmacy Department Austin Health Melbourne Australia
- Discipline of Pharmacy School of Health and Biomedical Sciences RMIT University Bundoora, Melbourne Australia
| | - Kent Garrett
- Pharmacy Department Austin Health Melbourne Australia
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7
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Maaskant JM, Tio MA, van Hest RM, Vermeulen H, Geukers VG. Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis. Health Sci Rep 2018; 1:e23. [PMID: 30623062 PMCID: PMC6200092 DOI: 10.1002/hsr2.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children. METHOD We performed an interrupted time series analysis with 6 preintervention and 6 postintervention data collection points, in a tertiary pediatric intensive care unit. We included intensive care patients admitted during July to December 2013 (preintervention) and July to December 2014 (postintervention). The primary endpoint was the prevalence of MEs per 100 prescriptions. We reviewed the clinical records of the patients and the incident reporting system for MEs. If an ME was suspected, a pediatrician-intensivist and a clinical pharmacist determined causality and preventability. They classified MEs as harmful according to the National Coordinating Council for Medication Error Reporting and Prevention categories. RESULTS We included 254 patients in the preintervention period and 230 patients in the postintervention period. We identified 153 MEs in the preintervention period, corresponding with 2.27 per 100 prescriptions, and 90 MEs in the postintervention period, corresponding with 1.71 per 100 prescriptions. Autoregressive integrated moving average analyses revealed a significant change in slopes between the preintervention and postintervention periods (β = -.21; 95% CI, -0.41 to -0.02; P = .04). We did not observe a significant decrease immediately after the start of the intervention (β = -.61; 95% CI, -1.31 to 0.08; P = .07). CONCLUSION The implementation of a structured medication audit, followed by feedback by a clinical pharmacist as part of the multidisciplinary team, resulted in a significant reduction of MEs in a tertiary pediatric intensive care unit.
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Affiliation(s)
- Jolanda M. Maaskant
- Department of Pediatric Intensive Care, Emma Children's HospitalAcademic Medical CenterAmsterdamThe Netherlands
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Medical FacultyAcademic Medical Center and University of AmsterdamAmsterdamThe Netherlands
- ACHIEVE Centre of Applied Research, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - Marieke A. Tio
- Department of Hospital PharmacyAcademic Medical CenterAmsterdamThe Netherlands
| | - Reinier M. van Hest
- Department of Hospital PharmacyAcademic Medical CenterAmsterdamThe Netherlands
| | - Hester Vermeulen
- ACHIEVE Centre of Applied Research, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare)Radboud University Medical CenterNijmegenThe Netherlands
| | - Vincent G.M. Geukers
- Department of Pediatric Intensive Care, Emma Children's HospitalAcademic Medical CenterAmsterdamThe Netherlands
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Hibbert PD, Molloy CJ, Hooper TD, Wiles LK, Runciman WB, Lachman P, Muething SE, Braithwaite J. The application of the Global Trigger Tool: a systematic review. Int J Qual Health Care 2017; 28:640-649. [PMID: 27664822 DOI: 10.1093/intqhc/mzw115] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022] Open
Abstract
Purpose This study describes the use of, and modifications and additions made to, the Global Trigger Tool (GTT) since its first release in 2003, and summarizes its findings with respect to counting and characterizing adverse events (AEs). Data sources Peer-reviewed literature up to 31st December 2014. Study selection A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data extraction Two authors extracted and compiled the demographics, methodologies and results of the selected studies. Results of data synthesis Of the 48 studies meeting the eligibility criteria, 44 collected data from inpatient medical records and four from general practice records. Studies were undertaken in 16 countries. Over half did not follow the standard GTT protocol regarding the number of reviewers used. 'Acts of omission' were included in one quarter of studies. Incident reporting detected between 2% and 8% of AEs that were detected with the GTT. Rates of AEs varied in general inpatient studies between 7% and 40%. Infections, problems with surgical procedures and medication were the most common incident types. Conclusion The GTT is a flexible tool used in a range of settings with varied applications. Substantial differences in AE rates were evident across studies, most likely associated with methodological differences and disparate reviewer interpretations. AE rates should not be compared between institutions or studies. Recommendations include adding 'omission' AEs, using preventability scores for priority setting, and re-framing the GTT's purpose to understand and characterize AEs rather than just counting them.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.,Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.,Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
| | - Tamara D Hooper
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.,Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.,Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
| | - William B Runciman
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.,Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.,Australian Patient Safety Foundation, PO Box 2471, IPC CWE-53, Adelaide, South Australia 5001, Australia
| | - Peter Lachman
- Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK
| | - Stephen E Muething
- James M. Anderson Center for HealthCare Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia
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Effect of a ward-based pharmacy team on preventable adverse drug events in surgical patients (SUREPILL study). Br J Surg 2015; 102:1204-12. [DOI: 10.1002/bjs.9876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/25/2015] [Accepted: 05/18/2015] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Surgical patients are at risk of adverse drug events (ADEs) causing morbidity and mortality. Much harm is preventable. Ward-based pharmacy interventions to reduce medication-related harm have not been evaluated in surgical patients.
Methods
This multicentre prospective clinical trial evaluated a protocolled, ward-based pharmacy method compared with standard pharmaceutical care in surgical patients. Allocation of study group was done by one-time randomization at ward level. Consecutive patients admitted for elective surgery with an expected hospital stay longer than 48 h were included. Pharmacy practitioners performed bedside medication reconciliation at admission and discharge, and hospital pharmacists undertook regular medication reviews in the study wards. Preventable ADEs and clinical outcomes were assessed.
Results
A total of 1094 surgical patients were studied. Some 880 specific interventions were made by the hospital pharmacist to improve pharmacotherapy in 309 of 547 patients on study wards. A further 547 patients were included on control wards. A crude non-significant reduction in incidence of preventable ADEs was seen on intervention wards in comparison with control wards (2·74 versus 3·84 preventable ADEs per 100 admissions; incidence rate ratio 0·71, 95 per cent c.i. 0·37 to 1·39; P = 0·324). After adjustment for differences in treatment groups and for potential confounding, the incidence rate ratio remained non-significant (0·82, 0·39 to 1·72; P = 0·598). No differences were seen for other outcomes, such as duration of hospital stay, number of complications and quality of life.
Conclusion
The present prospective controlled trial showed no significant reduction in medication-related harm or changes in clinical outcomes when surgical patients received protocolled ward-based pharmacy interventions.
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Visser A, Geboers B, Gouma DJ, Goslings JC, Ubbink DT. Predictors of surgical complications: A systematic review. Surgery 2015; 158:58-65. [DOI: 10.1016/j.surg.2015.01.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/18/2022]
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Boeker EB, Ram K, Klopotowska JE, de Boer M, Creus MT, de Andrés AL, Sakuma M, Morimoto T, Boermeester MA, Dijkgraaf MGW. An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non-surgical inpatients. Br J Clin Pharmacol 2015; 79:548-57. [PMID: 25199645 PMCID: PMC4386940 DOI: 10.1111/bcp.12504] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022] Open
Abstract
AIM The incidence of adverse drug events (ADEs) in surgical and non-surgical patients may differ. This individual patient data meta-analysis (IPDMA) identifies patient characteristics and types of medication most associated with patients experiencing ADEs and suggests target areas for reducing harm and implementing focused interventions. METHODS Authors of eligible studies on preventable ADEs (pADEs) were approached for collaboration. For assessment of differences among (non-)surgical patients and identification of associated factors descriptive statistics, Pearson chi-square, Poisson and logistic regression analyses were performed. For identification of high risk drugs (HRDs), a model was developed based on frequency, severity and preventability of medication related to ADEs. RESULTS Included were 5367 patients from four studies. Patients aged ≥ 77 years experienced more ADEs and pADEs compared with patients aged ≤ 52 years (odds ratios (OR) 2.12 (95% CI 1.70, 2.65) and 2.55 (95% CI 1.70, 3.84), respectively, both P < 0.05). Polypharmacy on admission also increased the risk of ADEs (OR 1.21 (95% CI 1.03, 1.44), P < 0.05) and pADEs (OR 1.85 (95% CI 1.34, 2.56), P < 0.05). pADEs were associated with more severe harm than non-preventable ADEs (54% vs. 32%, P < 0.05). The top five HRDs were antibiotics, sedatives, anticoagulants, diuretics and antihypertensives. Events associated with HRDs included diarrhoea or constipation, abnormal liver function test and central nervous system events. Most pADEs resulted from prescribing errors (90%). CONCLUSION Elderly patients with polypharmacy on admission and receiving antibiotics, sedatives, anticoagulants, diuretics or antihypertensives were more prone to experiencing ADEs. Efficiency in prevention of ADEs may be improved by targeted vigilance systems for alertness of physicians and pharmacists.
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Affiliation(s)
- Eveline B Boeker
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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12
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de Boer M, Ramrattan MA, Boeker EB, Kuks PFM, Boermeester MA, Lie-A-Huen L. Quality of pharmaceutical care in surgical patients. PLoS One 2014; 9:e101573. [PMID: 25006676 PMCID: PMC4090008 DOI: 10.1371/journal.pone.0101573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/07/2014] [Indexed: 11/26/2022] Open
Abstract
Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.
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Affiliation(s)
- Monica de Boer
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | - Maya A. Ramrattan
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | - Eveline B. Boeker
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Paul F. M. Kuks
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Loraine Lie-A-Huen
- Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands
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de Boer M, Boeker EB, Ramrattan MA, Kiewiet JJS, Dijkgraaf MGW, Boermeester MA, Lie-A-Huen L. Adverse drug events in surgical patients: an observational multicentre study. Int J Clin Pharm 2013; 35:744-52. [PMID: 23722455 DOI: 10.1007/s11096-013-9797-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/12/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Errors occurring during different steps of the medication process can lead to adverse drug events (ADEs). Surgical patients are expected to have an increased risk for ADEs during hospitalization. However, detailed information about ADEs in the surgical patient is lacking. OBJECTIVE In this study, we aim to measure the incidence and nature of (preventable) ADEs, potential risk factors for and outcome parameters of (preventable) ADEs in surgical patients. SETTING Observational multicentre cohort study in which eight surgical wards participated from three Dutch hospitals, all using computerized physician order entry (CPOE) systems with clinical decision support. METHODS Electively admitted surgical patients of the participating wards were included from March until June 2009. ADEs were measured using a standardized method with expert judgment. Incidence, severity, preventability and accountable medication were assessed. Poisson regression analysis was applied to determine the associations between possible risk factors and the occurrence of ADEs, expressed as incidence rate ratio (IRR). Also outcomes of ADEs in surgical patients were measured. MAIN OUTCOME MEASURE The incidence and nature of (preventable) ADEs in surgical patients. RESULTS A total of 567 surgical patients were included. We found an incidence of 27.5 ADEs and 4.2 preventable ADEs (pADEs) per 100 admissions (15.4 %). A quarter of the pADEs were severe or life-threatening. Opioids and anti-coagulation medication play a major role in the occurrence of ADEs and pADEs respectively. Univariate analysis revealed an American Society of Anesthesiologists classification of III or more as a risk factor for ADEs. Patients older than 65 years [IRR 2.77 (1.14-6.72)], with cardiovascular comorbidity [IRR 2.87 (1.13-7.28)], or undergoing vascular surgery [IRR 2.32 (1.01-5.32)] were at risk for pADEs. Patients experiencing an ADE had a significant longer duration of admission than patients without an ADE. CONCLUSIONS Surgical patients are at considerable risk of experiencing one or more ADEs during their admission, also in CPOE-hospitals. Risk factors for pADEs are age older than 65 years, cardiovascular comorbidity, and vascular surgery. Intensified monitoring may be needed in patients with a higher than average risk for pADEs.
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Affiliation(s)
- Monica de Boer
- Department of Hospital Pharmacy, Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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