Adverse Drug Events and Hospital Pharmacy Practice: Thinking Outside Our Box

Abstract

A dverse drug events are unfavourable occurrences related to the use and misuse of medications.1 It has been estimated that adverse drug events account for more than 17 million emergency department visits and almost 9 million hospital admissions annually in the United States.2,3 A cost-of-illness model published in 2001 estimated that annual costs associated with morbidity and mortality secondary to adverse drug events exceeded US$177 billion.3 Until recently, the effects of adverse drug events in Canada had not been characterized, but it is now evident that significant morbidity, mortality, and economic impact can be related to adverse drug events. More specifically, it has been estimated that as many as 25% of general medicine admissions and 12% of visits by adults to the emergency department in this country are directly related to adverse drug events, of which 70% are deemed preventable. 4,5 In the Canadian Adverse Events Study, 7.5% of all inpatients experienced an adverse event during their hospital stay and nearly 24% of the events were related to drug or fluid administration. 6 Finally, in another study, 23% of patients experienced an adverse event within 30 days after hospital discharge, 72% of the events were associated with drugs, and 50% of the events were preventable. 7These staggering data suggest that we have underestimated the magnitude of this problem but also that we are presented with a tremendous opportunity to explore and implement strategies for both inpatients and outpatients to reduce these events. In this issue of the CJHP, we have 3 papers that once again remind us of the impact of adverse drug events and drug-related problems in hospital patients. [8][9][10] For over 20 years, pharmaceutical care has been the framework for our inpatient practice models.11 Prolonged and continuous access to the patient, to the patient's information, and to other health care providers places hospital pharmacists in a unique practice setting ideal for the identification, resolution, and prevention of drug-related problems. However, despite attempts to improve the communication of patient information at the time of discharge to the community setting, it is well established that this transition is not seamless. Shortcomings in communication, follow-up, and monitoring place patients at risk in the immediate postdischarge period. 11,12 In the longer term, the system of dispersed health care providers in the community setting creates ongoing access and communication challenges. The community pharmacist's access to the patient's information and to other health care providers is also limited. Together, the complexities of these issues contribute to the high rates of adverse drug events that are seen both shortly after hospital discharge 8 and in the longer-term, ambulatory care setting. 13Examples exist of programs and practice models that attempt to address these problems. However, there remains an opportunity for hospital pharmacists, working with other health care providers, to further enhance the care provi...

Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins

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