Systems that prevent unwanted represcription of drugs withdrawn because of adverse drug events: a systematic review

Abstract

Represcription of medication that was withdrawn after the occurrence of an adverse drug event (including allergy), is a recognized medication safety issue on a patient level. We performed a systematic review to identify systems (electronic and nonelectronic) that can prevent the represcription of drugs withdrawn because of an adverse drug event and the effects of these systems. The review was performed using PRISMA and Cochrane guidelines. PubMed and Embase were searched for articles describing systems that can prevent represcription of drugs that had been withdrawn for causing an adverse drug event.Information on the characteristics of the studies, systems, and if present results achieved with such systems, was extracted. The results showed that of 6793 articles screened, 137 full-text articles were assessed for eligibility. A total of 45 studies describing 33 systems (28 electronic) were included. The five nonelectronic systems used allergy bracelets or allergy labels on hospital medical records or on drug orders. Systems differed in the way adverse drug events were documented and how users were alerted to drug represcription. Most systems functioned within a specific healthcare setting. Of 12 studies that compared pre-and post-intervention periods or wards with and without intervention, 7 showed a reduction in represcription after adverse drug event. In conclusion, several systems have been developed that can prevent the represcription of drugs that elicited an adverse drug event, but the evidence that these systems are effective is limited.

Severe cutaneous adverse reactions due to inappropriate medication use

“…Despite limited evidence that these systems are effective, some studies confirmed that the rate of adverse reactions caused by readministration of the suspected culprit drug decreased substantially after the introduction of the surveillance system. 37,38 Our study suggests that most prescriptions of antiepileptic drugs were appropriate. Epilepsy was the more frequent indication for aromatic and nonaromatic antiepileptic drugs, but antiepileptic drugs were also commonly prescribed for other indications such as bipolar disorder or neurological pain.…”

“…For instance, multiple electronic systems have been developed to prevent the readministration of drugs that were withdrawn because they caused an adverse drug reaction. 37 In all systems, a documented allergy triggered an alert to avoid represcription. Despite limited evidence that these systems are effective, some studies confirmed that the rate of adverse reactions caused by readministration of the suspected culprit drug decreased substantially after the introduction of the surveillance system.…”

Bridging the gap between hospital and primary care: the pharmacist home visit

“…Thus, to address post-discharge DRPs in the most efficient way with the highest impact, evidence tends to focus on discharge planning combined with home-based followup strategies [4]. The importance of adequate follow-up across healthcare settings is further illustrated by the fact that 27 % of drug treatments withdrawn during hospitalization as a result of an adverse drug reaction, had been represcribed post-discharge [10]. Additionally, a high number of readmissions occur in the days to weeks following hospital discharge of which a substantial percentage is drug-related [3].…”

Effectiveness of drug allergy card to prevent repeated prescribing of allergenic medications in a Malaysian public hospital

“…

Effectiveness of drug allergy card to prevent repeated prescribing of allergenic medications in a Malaysian public hospital To the editor:Information regarding drug allergy is often poorly documented in health care settings. [1][2][3] Despite being preventable, the repeated prescribing of known allergenic medications is still common, accounting for 8% to 15% of the medication errors worldwide. 2,[4][5][6][7] In response to the global concern about drug safety, the European Academy of Allergy and Clinical Immunology has recommended the use of drug allergy cards.

…”

“…[1][2][3] Despite being preventable, the repeated prescribing of known allergenic medications is still common, accounting for 8% to 15% of the medication errors worldwide. 2,[4][5][6][7] In response to the global concern about drug safety, the European Academy of Allergy and Clinical Immunology has recommended the use of drug allergy cards. 8 This method has long been implemented in public hospitals in Malaysia as a strategy to facilitate the communication of patients' drug allergy history, especially during emergency situations in which complete medical records and medication history are usually not available.…”