Factors Associated with Drug-Related Emergency Department Visits at a Teaching Hospital in Malaysia

Abstract

Introduction Adverse drug events (ADEs) are a significant health problem globally, with the emergency department (ED) being an important environment for the detection of ADEs. Data regarding drug-related visits to the ED in Malaysia are currently limited.Objectives The aim of this study was to determine factors associated with prescription drug-related ED visits at a teaching hospital. Methods A case-control study was conducted on patients who visited the ED of Hospital Universiti Sains Malaysia over a 7-week period between December 2014 and January 2015. A visit to the ED was considered drug-related if the chief presenting complaint was related to prescription drug use. Data were collected by interviewing patients, and also from the patient's medical record. Multiple logistic regression was applied to determine the risk factors. Results Overall, 144 physician-identified patients with drug-related ED visits were considered as cases and 288 patients with non-drug-related complaints were selected as controls. Independent risk factors identified for drug-related ED visits were female sex (adjusted odds ratio [OR] 1.7, 95% confidence interval [CI] 1.03-2.71), currently taking regular medication (OR 3.4, 95% CI 1.87-6.05), concurrent comorbidity (OR 2.3, 95% CI 1.28-4.10), a history of drug allergy (OR 5.36, 95% CI 2.30-12.48), and recent hospital admission (OR 2.85, 95% CI 1.23-4.10). Independent risk factors were also associated with the following health problems: diabetes mellitus (OR 6.83, 95% CI 3.30-14.12), central nervous system disorders (OR 9.42, 95% CI 3.08-14.12), and cardiovascular disorders (OR 2.5, 95% CI 1.25-4.79).Conclusions The determinants of a drug-related ED visit at a teaching hospital are multifactorial. Interventions to prevent future occurrences should focus on those patients at risk. Key PointsFemale sex, receiving regular medication, having a history of drug allergy, and recent hospital admission are risk factors for prescription drug-related emergency department (ED) visits.Patients with health problems such as diabetes, central nervous system disorders, and cardiovascular disorders also have a higher risk of ED visits related to drug use.The most common drug classes involved with drugrelated ED visits were antidiabetic agents, antihypertensives, antibiotics, anti-asthmatics, and diuretics.

Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia

“…HUSM is located in the state of Kelantan, Malaysia. It is a 767-bed tertiary hospital with about 65,000 patients attending the emergency department (ED) annually [23]. It is considered the largest referral center in the east coast of Malaysia [24].…”

Factors Associated With Medication Errors at a Teaching Hospital in Malaysia

“…11 The ED receives about 65 000 patients annually. 12 It has the red (ie, for critical cases), yellow (ie, semicritical cases), and green zone (ie, less or noncritical cases) triage, with an additional observation ward. The study was conducted between October 2017 and December 2017.…”

Understanding adverse drug-related emergency department visits: development of a conceptual model through a systematic review

“…These factors increase the likelihood of visiting an ED due to an ADE from medication use, and include a history of drug allergies, 44 chronic illness, 25 type II diabetes, essential hypertension and other comorbid conditions, 24,39, 45–47 psychopathology (personality and mood disorder), 30,48 mental illness, 25 recent hospital admission, 27 consulting multiple prescribers, 12 and pharmacies. 26 Other clinical factors include failure to correctly use, or not use, prescription medicines after being prescribed by a physician, 49 use of complementary and alternative medicine (CAM), 50 current medication use, 44 use of multiple medications, 17,21,33,35,51–53 yellow and red triage, 20 and use of drugs with narrow therapeutic indices. 31 Drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) used in the management of chronic diseases, 41 antihypertensive medications, 38 antidiabetics, 45 antibiotics, 38 benzodiazepines, antidepressants, anticonvulsants, 54 and use of nervous system drugs 22 were also identified as factors contributing to ED visits due to an ADE.…”

“…People in the community represent different socio-demographic characteristics. Some of these characteristics, such as old age, 18,19,40 female gender, 19,44 ethnic disparity (white), 28 low health practice index, 34 social disconnection (living alone), 30 long-term care, 27 and history of suicidal attempt, were all found to be associated with ADE-related ED visits. In addition, some individuals in the community will be involved in other use of drugs associated with ADE-related visits to the ED, such as nondependent drug abuse, 45 involuntary intoxication (e.g., unintentional poisoning), 23 self-medication, 37 use of short-acting Drug Enforcement Agency Schedule II opioids, 32 and use of cannabis and barbiturates 36 – all of which were found to be associated with ADE-related ED visits (see box on left side of general population in Figure 2).…”

“…People in the community also develop illnesses and require medications; thus, being exposed to many risk factors (termed clinical factors; see box on right side of general population in Figure 2). These factors increase the likelihood of visiting an ED due to an ADE from medication use, and include a history of drug allergies, 44 chronic illness, 25 type II diabetes, essential hypertension and other comorbid conditions, 24,39, 45–47 psychopathology (personality and mood disorder), 30,48 mental illness, 25 recent hospital admission, 27 consulting multiple prescribers, 12 and pharmacies. 26 Other clinical factors include failure to correctly use, or not use, prescription medicines after being prescribed by a physician, 49 use of complementary and alternative medicine (CAM), 50 current medication use, 44 use of multiple medications, 17,21,33,35,51–53 yellow and red triage, 20 and use of drugs with narrow therapeutic indices.…”