The Burden of Preventable Adverse Drug Events on Hospital Stay and Healthcare Costs in Japanese Pediatric Inpatients: The JADE Study

Background: Adverse drug events (ADEs) are a burden to the healthcare system. Preventable ADEs, which was ADEs due to medication errors, could be reduced if medication errors can be prevent or ameliorate. Objective: We investigated the burden of preventable ADEs on the length of hospital stay (LOS) and costs, and estimated the national burden of preventable ADEs in pediatric inpatients in Japan. Methods: We analyzed data from the Japan Adverse Drug Events (JADE) study on pediatric patients and estimated the incidence of preventable ADEs and associated extended LOS. Costs attributable to extended LOS by preventable ADEs were calculated using a national statistics database and we calculated the effect of preventable ADEs on national cost excess. Results: We included 907 patients with 7377 patient-days. Among them, 31 patients (3.4%) experienced preventable ADEs during hospitalization. Preventable ADEs significantly increased the LOS by 14.1 days, adjusting for gender, age, ward, resident physician, surgery during hospitalization, cancer, and severe malformation at birth. The individual cost due to the extended LOS of 14.1 days was estimated as USD 8258. We calculated the annual extra expense for preventable ADEs in Japan as USD 329 676 760. Sensitivity analyses, considering the incidence of preventable ADEs and the length of hospital stay, showed that the expected range of annual extra expense for preventable ADEs in Japan is between USD 141 468 968 and 588 450 708. Conclusion: Preventable ADEs caused longer hospitalization and considerable extra healthcare costs in pediatric inpatients. Our results would encourage further efforts to prevent and ameliorate preventable ADEs.

Using Electronic Health Records to Identify Adverse Drug Events in Ambulatory Care: A Systematic Review

Objective We identified the methods used and determined the roles of electronic health records (EHRs) in detecting and assessing adverse drug events (ADEs) in the ambulatory setting. Methods We performed a systematic literature review by searching PubMed and Google Scholar for studies on ADEs detected in the ambulatory setting involving any EHR use published before June 2017. We extracted study characteristics from included studies related to ADE detection methods for analysis. Results We identified 30 studies that evaluated ADEs in an ambulatory setting with an EHR. In 27 studies, EHRs were used only as the data source for ADE identification. In two studies, the EHR was used as both a data source and to deliver decision support to providers during order entry. In one study, the EHR was a source of data and generated patient safety reports that researchers used in the process of identifying ADEs. Methods of identification included manual chart review by trained nurses, pharmacists, and/or physicians; prescription review; computer monitors; electronic triggers; International Classification of Diseases codes; natural language processing of clinical notes; and patient phone calls and surveys. Seven studies provided examples of search phrases, laboratory values, and rules used to identify ADEs. Conclusion The majority of studies examined used EHRs as sources of data for ADE detection. This retrospective approach is appropriate to measure incidence rates of ADEs but not adequate to detect preventable ADEs before patient harm occurs. New methods involving computer monitors and electronic triggers will enable researchers to catch preventable ADEs and take corrective action.

P061: Preventable adverse drug events in Canadian emergency departments

Introduction: Adverse drug events (ADEs), unintended and harmful events associated with medications, cause or contribute to 2 million emergency department (ED) visits in Canada each year. Our objective was to determine the proportion of preventable ADEs by event type, severity, drug and drug class, and describe associated factors. Methods: We reviewed the charts of ADE patients enrolled in 1 of 3 prospective studies conducted in 3 tertiary care and 1 urban community ED. In the parent studies, researchers enrolled patients by applying a systematic selection algorithm to minimize selection bias, and physicians and pharmacists evaluated patients prospectively to evaluate causal associations between the drug regimens and patient presentations. After completion of the prospective study, a research pharmacist and physician independently reviewed the charts of all ADE patients, abstracted data using an electronic form and applied 3 preventability algorithms. The main outcome was a probably or definitely preventable ADE defined as avoidable by adhering to best medical practice, appropriate monitoring, taking a history of prior ADEs, compliance with recommended therapy, and avoidance of errors. Reviewers discussed discordant ratings until reaching consensus. We used kappa scores to evaluate between rater agreement, and investigated risk factors for preventability using logistic regression. Sample size was based on enrolment into the parent studies. Results: We reviewed the charts of 670 patients diagnosed with 725 ADEs. We excluded 44 patients with incomplete assessments. The inter-rater agreement in categorizing ADEs as preventable was 0.51 (95%CI 0.42-0.59). We deemed 61% (95%CI 57-65%) of ADEs preventable. Of preventable events, 30% were due to non-adherence, 24% to adverse reactions, and 15% to an excessive dose, and 29% required hospital admission. Among preventable events, 8% were due to warfarin, 5% hydrochlorothiazide, 3% acetylsalicylic acid, and 3% insulin. On multivariate analysis, mental health diagnoses were associated with preventable ADEs (OR 2.1, 95%CI 1.3-3.3, p=0.002). Conclusion: In this large multi-centre cohort, preventable events made up the majority of ADEs, and utilized substantial hospital resources. Strategies to reduce ED visits due to ADEs should target improving adherence behavior, and developing interventions for patients with mental health diagnoses and on high-risk medications.

Patient Characteristics Associated with Adverse Drug Events in Hospital: An Overview of Reviews

<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Adverse drug events (ADEs) occurring in hospital inpatients can have serious implications. The ability to identify and prioritize patients at higher risk of ADEs could help pharmacists to optimize their impact as members of the patient care team.</p><p><strong>Objective:</strong> To identify risk factors, patient characteristics, and medications associated with a higher likelihood of ADEs in adult inpatients through an overview of reviews on this topic.</p><p><strong>Data Sources:</strong> Systematic reviews and narrative reviews or guidelines identified through a search of MEDLINE and the Cochrane Database of Systematic Reviews (limited to articles published from 1995 to June 4, 2015), as well as a grey literature search.</p><p><strong>Study Selection and Data Extraction:</strong> For inclusion in this overview, a review had to discuss patient characteristics or risk factors associated with ADEs, medications associated with ADEs, or drug–drug interactions associated with ADEs, in adult inpatients. Articles retrieved by the literature search were screened for eligibility by a single reviewer.</p><p><strong>Data Synthesis:</strong> Eleven articles were deemed eligible for inclusion in this overview: 4 systematic reviews and 7 narrative reviews or guidelines. Their results were described narratively. Older age and polypharmacy were the most frequently cited risk factors associated with ADEs in hospital inpatients. Renal impairment, female sex, and decline in cognition were also frequently reported as being associated with ADEs. Medication classes reported to be associated with ADEs during the hospital stay included anticoagulants, anti-infectives/antibiotics, antidiabetic agents, analgesics (including opioids and nonsteroidal anti-inflammatory drugs), and cardiovascular drugs (including antihypertensive agents, diuretics, and digoxin). Two publications reported on preventable ADEs in hospital inpatients; the medications associated with preventable ADEs were consistent with those reported above.</p><p><strong>Conclusions:</strong> The risk factors, patient characteristics, and medication classes highlighted in this overview may help clinicians to prioritize patient populations who may be at higher risk of ADEs.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> Les événements indésirables liés aux médicaments (EIM) touchant les patients hospitalisés peuvent avoir de graves conséquences. La capacité d’identifier les patients qui présentent un haut risque d’EIM et de les prioriser pourrait aider les pharmaciens à optimiser l’influence qu’ils exercent comme membres de l’équipe de soins aux patients.</p><p><strong>Objectif :</strong> Identifier les facteurs de risque, les caractéristiques des patients ou les médicaments associés à un potentiel plus élevé d’EIM chez les patients adultes hospitalisés à l’aide d’une synthèse des comptes rendus sur le sujet.</p><p><strong>Sources des données :</strong> Des analyses systématiques et des revues narratives ou des lignes directrices trouvées à l’aide d’une recherche dans MEDLINE et la Cochrane Database of Systematic Reviews (se limitant aux articles publiés entre 1995 et le 4 juin 2015) et d’une recherche dans la littérature grise.</p><p><strong>Sélection des études et extraction des données :</strong> Afin d’être admissible à la présente synthèse, un compte rendu devait aborder les caractéristiques des patients ou les facteurs de risque associés aux EIM, les médicaments associés aux EIM ou les interactions médicament médicament associées aux EIM chez le patient adulte hospitalisé. L’admissibilité des articles trouvés grâce à la recherche documentaire n’a été évaluée que par une seule personne.</p><p><strong>Synthèse des données :</strong> Les résultats des comptes rendus retenus ont été décrits de manière narrative. Onze articles ont été admis dans la présente synthèse : quatre analyses systématiques et sept revues narratives ou lignes directrices. L’âge avancé et la polypharmacie représentaient les facteurs de risque associés aux EIM les plus souvent mentionnés chez le patient adulte hospitalisé. L’insuffisance rénale, le sexe féminin et le déclin cognitif étaient eux aussi fréquemment indiqués comme étant des facteurs liés aux EIM. Parmi les classes de médicaments signalées comme étant associées aux EIM pendant le séjour à l’hôpital, on comptait : les anticoagulants, les anti-infectieux et les antibiotiques, les antidiabétiques, les analgésiques (notamment les opioïdes et les anti-inflammatoires non stéroïdiens) et les agents cardiovasculaires (notamment les antihypertenseurs, les diurétiques et la digoxine). Deux publications abordaient les EIM évitables chez le patient hospitalisé; les médicaments associés aux EIM faisaient partie de ceux mentionnés ci-dessus.</p><p><strong>Conclusion :</strong> Connaître les facteurs de risque, les caractéristiques des patients et les classes de médicaments mis en évidence dans la présente synthèse peut aider les cliniciens à accorder la priorité aux populations de patients qui pourraient présenter un plus grand risque d’EIM.</p>