Incidence and preventability of adverse drug events in hospitalized adults
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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.
- Medical Practice Study. Patients, Doctors and Lawyers: Studies of Medical Injury in New York. Boston: Harvard University, 1990.
- National Association of Insurance Commissioners. Medical Malpractice Closed Claims, 1975–1978. Brookfield, WI: National Association of Insurance Commissioners, 1980.
- Keith MR, Bellanger-McCleery RA, Fuchs JE Jr. Multidisciplinary program for detecting and evaluating adverse drug reactions. Am J Hosp Pharm. 1989;46:1809–12.
- Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991;266:2847–51. CrossRef
- Faich GA. Adverse-drug-reaction monitoring. N Engl J Med. 1986;314:1589–92. 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, et al. A method of estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45. CrossRef
- Feinstein AR. Clinical epidemiology: the architecture of clinical research. Philadelphia: W. B. Saunders, 1985.
- Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74. CrossRef
- Jick H. Adverse drug reactions: the magnitude of the problem. J Allergy Clin Immunol. 1984;74:555–7. CrossRef
- Leape LL, Brennan TA, Laird NM, et al. The nature of adverse events in hospitalized patients: results from the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377–84. CrossRef
- Brennan TA, Leape LL, Laird N, et al. Incidence of adverse events and negligence in hospitalized patients: results from the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370–6. CrossRef
- Karch FE, Lasagna L. Adverse drug reactions: a critical review. JAMA. 1975;234:1236–41. CrossRef
- Brown GC. Medication errors: a case study. Hospitals. 1979;53:61–2, 65.
- Melmon KL. Preventable drug reactions—causes and cures. Boston: Seminars in Medicine of the Beth Israel Hospital, 1971:284:1361–7.
- Health and Public Policy Committee, American College of Physicians. Improving medical education in therapeutics. Ann Intern Med. 1988;108:145–7.
- Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79:718–22.
- Blum KV, Abel SR, Urbanski CJ, Pierce JM. Medication error prevention by pharmacists. Am J Hosp Pharm. 1988;45:1902–3.
- Lesar TS, Briceland LL, Delcoure K, Parmalee JC, Masta-Gornic V, Pohl H. Medication prescribing errors in a teaching hospital. JAMA. 1990;263:2329–34. CrossRef
- Dubois RW, Brook RH. Preventable deaths: who, how often, and why? Ann Intern Med. 1988;190:582–9.
- Caplan RA, Posner KL, Cheney FW. Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265:1957–60. 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