Incidence and preventability of adverse drug events in hospitalized adults
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective: To evaluate the incidence and preventability of adverse drug events (ADEs) and to determine the yield of several strategies for identifying them.
Design: Prospective cohort study.
Setting: Seven units, including two medical, two surgical, and two obstetric general care units and a coronary intensive care unit in an urban tertiary care hospital.
Patients: All patients on these units over a 37-day period (2,967 patient-days).
Methods: Events were identified in three ways: 1) logs were placed on each unit and satellite pharmacy for nurses and pharmacists to record incidents; 2) a research nurse solicited reports of incidents twice daily on each unit; and 3) the nurse reviewed all charts at least daily. Incidents were classified by two independent reviewers as ADEs or potential ADEs.
Results: The rate of drug-related incidents was 73 in 2,967 patient-days; 27 incidents were judged ADEs, 34 potential ADEs, and 12 problem orders. Fifty different drugs were involved. Physicians were primarily responsible for 72% of the incidents, with the remainder divided evenly between nursing, pharmacy, and clerical personnel. Of the 27 ADEs, five were life-threatening, nine were serious, and 13 were significant. Fifteen (56%) of the 27 were judged definitely or probably preventable. Incidents were discovered about equally often from the logs and by chart review. However, when the incidents in which an ADE was present were compared with the remainder of incidents, the authors found that 67% (18 of 27) of the ADEs were identified only by chart review (p<0.001), and physicians were more often judged responsible than other personnel (p<0.001).
Conclusions: The authors conclude that ADEs are not infrequent, often preventable, and usually caused by physician decisions. In this study, solicited reporting by nurses and pharmacists was inferior to chart review for identifying ADEs, but was effective for identifying potential ADEs. Optimal prevention strategies should cover many types of drugs and target physicians’ ordering practices.
- Patients, Doctors and Lawyers: Studies of Medical Injury in New York. Harvard University, Boston
- Medical Malpractice Closed Claims, 1975–1978. National Association of Insurance Commissioners, Brookfield, WI
- Keith, MR, Bellanger-McCleery, RA, Fuchs, JE (1989) Multidisciplinary program for detecting and evaluating adverse drug reactions. Am J Hosp Pharm 46: pp. 1809-12
- Classen, DC, Pestotnik, SL, Evans, RS, Burke, JP (1991) Computerized surveillance of adverse drug events in hospital patients. JAMA 266: pp. 2847-51 CrossRef
- Faich, GA (1986) Adverse-drug-reaction monitoring. N Engl J Med 314: pp. 1589-92 CrossRef
- World Health Organization. International drug monitoring: the role of the hospital. WHO Tech Rep Ser No. 425, 1969.
- Naranjo, CA, Busto, U, Sellers, EM (1981) A method of estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30: pp. 239-45 CrossRef
- Feinstein, AR (1985) Clinical epidemiology: the architecture of clinical research. W. B. Saunders, Philadelphia
- Landis, RJ, Koch, GG (1977) The measurement of observer agreement for categorical data. Biometrics 33: pp. 159-74 CrossRef
- Jick, H (1984) Adverse drug reactions: the magnitude of the problem. J Allergy Clin Immunol 74: pp. 555-7 CrossRef
- Leape, LL, Brennan, TA, Laird, NM (1991) The nature of adverse events in hospitalized patients: results from the Harvard Medical Practice Study II. N Engl J Med 324: pp. 377-84 CrossRef
- Brennan, TA, Leape, LL, Laird, N (1991) Incidence of adverse events and negligence in hospitalized patients: results from the Harvard Medical Practice Study I. N Engl J Med 324: pp. 370-6 CrossRef
- Karch, FE, Lasagna, L (1975) Adverse drug reactions: a critical review. JAMA 234: pp. 1236-41 CrossRef
- Brown, GC (1979) Medication errors: a case study. Hospitals 53: pp. 61-2
- Melmon, KL (1971) Preventable drug reactions—causes and cures. Seminars in Medicine of the Beth Israel Hospital, Boston
- American College of Physicians. Improving medical education in therapeutics. Ann Intern Med 108: pp. 145-7
- Folli, HL, Poole, RL, Benitz, WE, Russo, JC (1987) Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics 79: pp. 718-22
- Blum, KV, Abel, SR, Urbanski, CJ, Pierce, JM (1988) Medication error prevention by pharmacists. Am J Hosp Pharm 45: pp. 1902-3
- Lesar, TS, Briceland, LL, Delcoure, K, Parmalee, JC, Masta-Gornic, V, Pohl, H (1990) Medication prescribing errors in a teaching hospital. JAMA 263: pp. 2329-34 CrossRef
- Dubois, RW, Brook, RH (1988) Preventable deaths: who, how often, and why?. Ann Intern Med 190: pp. 582-9
- Caplan, RA, Posner, KL, Cheney, FW (1991) Effect of outcome on physician judgments of appropriateness of care. JAMA 265: pp. 1957-60 CrossRef
- Incidence and preventability of adverse drug events in hospitalized adults
Journal of General Internal Medicine
Volume 8, Issue 6 , pp 289-294
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- adverse drug events
- adverse drug reactions
- physician decisions
- Industry Sectors
- Author Affiliations
- 1. the Division of General Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, USA
- 2. the Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts