Adverse drug events in children during hospitalization and after discharge in a Norwegian University Hospital

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.

Download Full-text

A Web-Based Clinical System for Cohort Surveillance of Specific Clinical Effectiveness and Safety Outcomes: A Cohort Study of Non–Vitamin K Antagonist Oral Anticoagulants and Warfarin

JMIR Medical Informatics ◽

10.2196/13329 ◽

2019 ◽

Vol 7 (3) ◽

pp. e13329 ◽

Cited By ~ 1

Author(s):

Fong-Ci Lin ◽

Shih-Tsung Huang ◽

Rung Ji Shang ◽

Chi-Chuan Wang ◽

Fei-Yuan Hsiao ◽

...

Keyword(s):

Ischemic Stroke ◽

Surveillance System ◽

Adverse Drug Events ◽

Medical Center ◽

Oral Anticoagulants ◽

Critical Role ◽

Clinical Effectiveness ◽

University Hospital ◽

Drug Surveillance ◽

Web Based

Background Conventional systems of drug surveillance lack a seamless workflow, which makes it crucial to have an active drug surveillance system that proactively assesses adverse drug events. Objective The aim of this study was to develop a seamless, Web-based workflow for comparing the safety and effectiveness of drugs in a database of electronic medical records. Methods We proposed a comprehensive integration process for cohort surveillance using the National Taiwan University Hospital Clinical Surveillance System (NCSS). We studied a practical application of the NCSS that evaluates the drug safety and effectiveness of novel oral anticoagulants (NOACs) and warfarin by cohort tree analysis in an efficient and interoperable platform. Results We demonstrated a practical example of investigating the differences in effectiveness and safety between NOACs and warfarin in patients with nonvalvular atrial fibrillation (AF) using the NCSS. We efficiently identified 2357 patients with nonvalvular AF with newly prescribed oral anticoagulants between 2010 and 2015 and further developed 1 main cohort and 2 subcohorts for separately measuring ischemic stroke as the clinical effectiveness outcome and intracranial hemorrhage (ICH) as the safety outcome. In the subcohort of ischemic stroke, NOAC users exhibited a significantly lower risk of ischemic stroke than warfarin users after adjusting for age, sex, comorbidity, and comedication in an intention-to-treat (ITT) analysis (P=.01) but did not exhibit a significantly distinct risk in an as-treated (AT) analysis (P=.12) after the 2-year follow-up. In the subcohort of ICH, NOAC users did not exhibit a different risk of ICH both in ITT (P=.68) and AT analyses (P=.15). Conclusions With a seamless and Web-based workflow, the NCSS can serve the critical role of forming associations between evidence and the real world at a medical center in Taiwan.

Download Full-text

‘Start smart’: using front-line ownership to improve the quality of empiric antibiotic prescribing in a paediatric hospital

BMJ Open Quality ◽

10.1136/bmjoq-2018-000445 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000445

Author(s):

Robert Cunney ◽

Michelle Kirrane-Scott ◽

Aisling Rafferty ◽

Patrick Stapleton ◽

Ikechukwu Okafor ◽

...

Keyword(s):

Adverse Drug Events ◽

Point Of Care ◽

University Hospital ◽

Antibiotic Prescribing ◽

Front Line ◽

Improvement Project ◽

Paediatric Hospital ◽

Prescribing Quality ◽

Data Feedback ◽

Empiric Antibiotic

Infection is the most frequent indication for non-scheduled admission to paediatric hospitals, leading to high levels of empiric antibiotic prescribing. Antibiotic prescribing in line with local guidelines, improves patient outcomes, reduces adverse drug events and helps to reduce the emergence of antimicrobial resistance. We undertook an improvement project at Temple Street Children’s University Hospital targeting documentation of indication and compliance with empiric antibiotic prescribing guidelines among medical admissions via the emergency department (ED). Results of weekly audits of empiric antibiotic prescribing were fed back to prescribers. Front-line ownership techniques were used to empower prescribers to generate ideas for change, such as regular discussion of antibiotic prescribing issues at weekly clinical meetings, antibiotic ‘spot quiz’, updates to prescribing guidelines, improved access and promotion of a prescribing app, laminated guideline summary cards, and reminders and guideline summaries at a point of prescribing in ED. Documentation of indication and guideline compliance increased from a median of 30% in December 2014 to 100% in March 2015, and was sustained at 100% to September 2016, then 90% to December 2017. The intervention was associated with improvements in non-targeted indicators of prescribing quality, an overall reduction in antimicrobial consumption in the hospital, and a €105 000 reduction in annual antimicrobial acquisition costs. We found that a simple, paper-based, data collection system was effective, provided opportunities for a point-of-care interaction with prescribers, and facilitated weekly data feedback. We also found that using a pre-existing weekly clinical meeting to foster prescriber ownership of the data, allowing prescribers to identify possible tests of change, and exploiting the competitive nature of doctors, led to a rapid and sustained improvement in prescribing quality. Awareness of local prescribing processes and culture are essential to delivering improvements in antimicrobial stewardship.

Download Full-text

The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01791-5 ◽

2021 ◽

Author(s):

Socheat Cheng ◽

Tahreem Ghazal Siddiqui ◽

Michael Gossop ◽

Torgeir Bruun Wyller ◽

Espen Saxhaug Kristoffersen ◽

...

Keyword(s):

Older Patients ◽

Geriatric Patients ◽

Adverse Drug Events ◽

Rating Scale ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional ◽

Multiple Substance ◽

The Relationship ◽

Addictive Drug

Abstract Background Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied. Aims This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users. Methods We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians. Results Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, p < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases. Conclusions Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients.

Download Full-text

Advanced Point of Care System for reducing Adverse Drug Events using 13.56/900 MHz RFID, Wi-Fi, Text-To-Speech Technology in Ajou University Hospital

World Congress on Medical Physics and Biomedical Engineering 2006 - IFMBE Proceedings ◽

10.1007/978-3-540-36841-0_92 ◽

2007 ◽

pp. 335-338 ◽

Cited By ~ 1

Author(s):

Ho-Young Byun ◽

Kyung-Jin Lee ◽

Sang-Hun Lee ◽

Young-Ho Lee ◽

Un-Gu Kang ◽

...

Keyword(s):

Adverse Drug Events ◽

Point Of Care ◽

University Hospital ◽

Text To Speech ◽

Speech Technology ◽

Point Of Care System ◽

Care System

Download Full-text

Adverse drug events in an intensive care unit of a university hospital

European Journal of Clinical Pharmacology ◽

10.1007/s00228-010-0987-y ◽

2011 ◽

Vol 67 (6) ◽

pp. 625-632 ◽

Cited By ~ 35

Author(s):

Adriano Max Moreira Reis ◽

Silvia Helena De Bortoli Cassiani

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adverse Drug Events ◽

University Hospital

Download Full-text

Life-Threatening and Fatal Adverse Drug Events in a Danish University Hospital

Journal of Patient Safety ◽

10.1097/pts.0000000000000411 ◽

2017 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 1

Author(s):

Olga A. Tchijevitch ◽

Lars Peter Nielsen ◽

Marianne Lisby

Keyword(s):

Adverse Drug Events ◽

University Hospital ◽

Life Threatening

Download Full-text

Patient safety incident reports related to traditional Japanese Kampo medicines: medication errors and adverse drug events in a university hospital for a ten-year period

BMC Complementary and Alternative Medicine ◽

10.1186/s12906-017-2051-2 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 5

Author(s):

Yutaka Shimada ◽

Makoto Fujimoto ◽

Tatsuya Nogami ◽

Hidetoshi Watari ◽

Hideyuki Kitahara ◽

...

Keyword(s):

Patient Safety ◽

Medication Errors ◽

Adverse Drug Events ◽

University Hospital ◽

Safety Incident ◽

Patient Safety Incident ◽

Incident Reports

Download Full-text

Trigger alerts associated with laboratory abnormalities on identifying potentially preventable adverse drug events in the intensive care unit and general ward

Therapeutic Advances in Drug Safety ◽

10.1177/2042098618760995 ◽

2018 ◽

Vol 9 (4) ◽

pp. 207-217 ◽

Cited By ~ 4

Author(s):

Mitchell S. Buckley ◽

Jeffrey R. Rasmussen ◽

Dale S. Bikin ◽

Emily C. Richards ◽

Andrew J. Berry ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Adverse Drug Events ◽

Continuous Process ◽

General Ward ◽

Hospitalized Patients ◽

University Hospital ◽

Continuous Process Improvement ◽

Drug Induced

Background Medication safety strategies involving trigger alerts have demonstrated potential in identifying drug-related hazardous conditions (DRHCs) and preventing adverse drug events in hospitalized patients. However, trigger alert effectiveness between intensive care unit (ICU) and general ward patients remains unknown. The objective was to investigate trigger alert performance in accurately identifying DRHCs associated with laboratory abnormalities in ICU and non-ICU settings. Methods This retrospective, observational study was conducted at a university hospital over a 1-year period involving 20 unique trigger alerts aimed at identifying possible drug-induced laboratory abnormalities. The primary outcome was to determine the positive predictive value (PPV) in distinguishing drug-induced abnormal laboratory values using trigger alerts in critically ill and general ward patients. Aberrant lab values attributed to medications without resulting in an actual adverse event ensuing were categorized as a DRHC. Results A total of 634 patients involving 870 trigger alerts were included. The distribution of trigger alerts generated occurred more commonly in general ward patients (59.8%) than those in the ICU (40.2%). The overall PPV in detecting a DRHC in all hospitalized patients was 0.29, while the PPV in non-ICU patients (0.31) was significantly higher than the critically ill (0.25) ( p = 0.03). However, the rate of DRHCs was significantly higher in the ICU than the general ward (7.49 versus 0.87 events per 1000 patient days, respectively, p < 0.0001). Although most DRHCs were considered mild or moderate in severity, more serious and life-threatening DRHCs occurred in the ICU compared with the general ward (39.8% versus 12.4%, respectively, p < 0.001). Conclusions Overall, most trigger alerts performed poorly in detecting DRHCs irrespective of patient care setting. Continuous process improvement practices should be applied to trigger alert performance to improve clinician time efficiency and minimize alert fatigue.

Download Full-text