Detecting adverse drug events during the hospital stay

Culleré, C. Berga; Torner, Maria; Ruíz, Jesús; Creus, M Tuset; Martin, Molinda; Sunyer, M. Capdevila; Gubert, M. Torres; Cortinas, M.T. Casajoana; Sabaté, E. Baró; Sola, Joan; Besolí, Anisi Morón; Estradé, E. Òdena; Benavente, J Serrais; Farrero, M.T. Vitales; Jané, Carlos Codina

doi:10.1016/s2173-5085(09)70095-4

Cited by 10 publications

(14 citation statements)

References 11 publications

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“…Only two studies fulfilled the inclusion criteria and provided information on ADEs and their preventability in surgical as well as non‐surgical patients. Their data were combined with two eligible studies performed in our centre (Figure l). All four included studies were prospective observational multicentre studies.…”

Section: Resultsmentioning

confidence: 99%

“…Next, the focus was on the type of medication accountable for ADEs . For the additional analysis, data from only three studies were used , since one study had only analyzed the severity on pADEs . Applying the weighing model as described in the methods section, resulted in a top five of HRDs: antibiotics, sedatives, anticoagulants, diuretics and antihypertensives (Table ).…”

Section: Resultsmentioning

confidence: 99%

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An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

Boeker

Ram

Klopotowska

et al. 2015

Brit J Clinical Pharma

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AIMThe 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. METHODSAuthors 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. RESULTSIncluded 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%). CONCLUSIONElderly 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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

Boeker

Ram

Klopotowska

et al. 2015

Brit J Clinical Pharma

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“…It was estimated that the prevalence of resolved potential drug-related problems might be up to 35% and 10% of the patients in the intervention4 and control18 groups, respectively. We assumed that 10% of patients would be lost to follow-up.…”

Section: Methodsmentioning

confidence: 99%

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

et al. 2017

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BackgroundThe resolution of potential drug-related problems is a priority of pharmaceutical care programmes.ObjectivesTo assess the clinical impact on drug-related negative outcomes of a pharmaceutical care programme focusing on the resolution of potential drug-related problems, initiated in the emergency department for patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD).MethodsControlled trials, in which older adults (≥65 years) receiving four or more medications admitted to the emergency department for ≥12 hours for worsening of HF and/or COPD were randomised (1:1) to either a pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department (intervention group (IG)) or standard care (control group). Comparisons between the groups were made for the proportion of patients with drug-related negative outcomes, number of drug-related negative outcomes per patient, mean stay, patients readmitted within 180 days and 180-day mortality.Results118 patients were included, 59 in each group. Fewer patients in the IG had drug-related negative outcomes (37 (62.7%) vs 47 (79.7%) in the control group (p=0.042)). Fewer drug-related negative outcomes per patient occurred in the IG (56 (0.95 per patient) vs 85 (1.44 per patient) in the control group (p=0.01)). The mean stay was similar between groups (194.7 hours in the IG vs 242.5 hours in the control group (p=0.186)). No difference in revisits within 180 days was found (32 (54.24%) in the IG vs 22 (37.3%) in the control group (p=0.065)). 180-Day mortality was detected in 11 (18.6%) patients in the IG compared with 13 (22%) in the control group (p=0.647).ConclusionA pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department has a favourable clinical impact, as it reduces the number and prevalence of drug-related negative outcomes. No difference was found in other outcome variables.Trial registration number NCT02368548.

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“…30,[44][45][46] In the remaining studies (8), it is not clear whether such events were included. 27,29,[47][48][49][50][51][52] Nine articles did not define the profile of the team involved in identifying and evaluating the events, 26,27,29,30,[36][37][38]49,50 and only three mentioned team training. 28,44,46 Nearly all the articles, except two, 36,48 described standardization of data collection and ADE case identification procedures.…”

Section: Quality Assessment Of Studiesmentioning

confidence: 99%

“…[27][28][29][30][31][32] Of the 28 studies included, 13 identified and assessed avoidable events separately. 25,26,[31][32][33][34][35][36][37][38][39][40][41] Three studies restricted the analysis to ADRs, clearly excluding the avoidable events. 28,42,43 Four studies used ADE definitions and did not assess avoidability and did not present data on avoidable event frequency.…”

Section: Quality Assessment Of Studiesmentioning

confidence: 99%

Adverse drug events among adult inpatients: a meta-analysis of observational studies

2014

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SUMMARYWhat is known and objective: Studies in a number of countries have shown that adverse drug events (ADE) occur frequently among hospital inpatients. The objective of this study was to conduct a systematic review of observational studies of the frequency of ADE in adult inpatients and to examine factors associated with observed heterogeneity in the reported results. Methods: The systematic review included observational studies, which identified and analysed ADE during hospitalization of adult inpatients. The literature search was conducted on MED-LINE, Embase, Lilacs and Google Scholar (January of 2000 to June of 2013). Article selection, quality assessment and information extraction were performed by two of the authors, working independently. Using the random-effects model, the proportion of patients with adverse events was used as an outcome measure. Proportion was estimated for subgroups based on event identification method: stimulated reporting (SR), retrospective monitoring (RM) and prospective monitoring (PM). For the latter group, meta-regression was used to identify sources of heterogeneity in the estimates. Results and discussion: Twenty-eight articles from the 7550 identified met our inclusion criteria. The articles were heterogeneous in terms of quality, outcome definition and event identification method and in the corresponding descriptions. Of the 28 articles selected, 25 were included in the corresponding quantitative summary: four used SR, six RM and 15 PM, returning incidences of 2Á3% (CI 95%: 1Á6-4Á5), 8Á7% (CI 95%: 4Á8-15Á3) and 21Á3% (CI 95%: 15Á7-28Á3), respectively, and I 2 greater than 95%. There were other sources of heterogeneity, including the use of combined strategies within each subgroup. In the PM subgroup, using multivariate meta-regression model, no variables were found to associate with proportion. What is new and conclusion: Event frequency seems to associate with the event identification method. PM returned the highest estimates. This subgroup used a greater diversity of approaches for event identification and more diverse data sources. Improved recording of information on the event identification method, the characteristics of the events and the conduct of the study would enable more reliable and precise estimates of the frequency of ADE among hospital inpatients. WHAT IS KNOWN AND OBJECTIVEHospital studies in a number of countries have identified high incidences of drug-related adverse events occurring during hospital stay. The estimates are high and vary widely across studies. In recent years, meta-analyses have been made to summarize the frequency of such events.1,2 Other reviews of the frequency of drug-related events among adult inpatients have either included only the ones identified at admission 3,4 or did not calculate summary measures. 5,6 Systematic reviews aiming to estimate the prevalence or incidence of events are often complicated by heterogeneity of eligible studies. However, the aim of a meta-analysis is not only to compute a summary measure but also to hig...

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Detecting adverse drug events during the hospital stay

Cited by 10 publications

References 11 publications

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial

Adverse drug events among adult inpatients: a meta-analysis of observational studies

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