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International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 727–735 | Cite as

Drug-related visits to the emergency department in a Spanish university hospital

  • Isabel CastroEmail author
  • José Mª Guardiola
  • Laura Tuneu
  • Mª Luisa Sala
  • Mª José Faus
  • Mª Antonia Mangues
Research Article

Abstract

Background Negative outcomes of medications (NOMs) are a major public health problem that impact on patients’ quality of life. As many NOMs are avoidable, it is necessary to determine their causes in each health setting in order to plan preventive strategies. Objective The aims of this study were to assess the frequency, type, severity, and preventability of NOMs that result in emergency department visits, to identify the main medications involved, and to determine factors associated with their development in a general hospital in Spain. Setting Emergency department of a 650-bed university tertiary hospital. Methods Descriptive, cross-sectional study. On each study day, a pharmacist administered a questionnaire to one in every three patients awaiting consultation. Information was also obtained from the emergency medical records. Emergency department visits were identified as NOMs on the basis of assessment by a pharmacist and a physician. A second pharmacist and physician reassessed the same cases. Discrepancies were adjudicated by an external team of two pharmacists and a physician. Main outcome measures number of NOMs detected, severity and preventability of the NOMs detected, medications involved in these NOMs, and factors associated with NOMs. Results A NOM was detected in 221 of 588 patients analyzed (37.6 %). In relation to NOM severity, 59.3 % were mild, 34.4 % were moderate and 6.3 % were severe. One hundred and fifty-seven of the 221 NOMs (71 %) were considered preventable. Drugs most frequently involved in NOMs were nervous system agents (22.1 %), musculo-skeletal system agents (19.1 %), and anti-infective agents for systemic use (17.6 %). Mean number of drugs taken was the only factor associated with NOMs. Conclusion The high number of NOMs detected indicates that closer pharmacotherapy follow up is needed to avoid such events in our setting.

Keywords

Clinical pharmacy Drug-related problems Emergency department Hospital Negative outcomes Pharmaceutical care Spain 

Notes

Acknowledgments

The authors thank the physicians in the ED and the pharmacists of the Pharmacy Department who participated in this study, as well as to Carolyn Newey for her assistance with the manuscript and I. Gich for supporting statistical analysis.

Funding

Data from this study correspond to part of a research project funded by the National Health Research Fund.

Conflicts of interest

None.

References

  1. 1.
    World Health Organization. International drug monitoring: the role of the hospital. Geneva: WHO; 1969. Technical Report Series; 425. Available at: http://www.who.int/iris/handle/10665/40747. Accessed: 12 Feb 2013.
  2. 2.
    Baena MI, Faus MJ, Fajardo PC, Luque FM, Sierra F, Martinez-Olmos J, et al. Medicine-related problems resulting in emergency department visits. Eur J Clin Pharmacol. 2006;62:387–93.PubMedCrossRefGoogle Scholar
  3. 3.
    Patel P, Zed PJ. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy. 2002;22:915–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Queneau P, Bannwarth B, Carpentier F, Guliana JM, Bouget J, Trombert B, et al. Emergency department visits caused by adverse drug events: results of a French survey. Drug Saf. 2007;30:81–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Prince BS, Goetz CM, Rihn TL, Olsky M. Drug-related emergency department visits and hospital admissions. Am J Hosp Pharm. 1992;49:1696–700.PubMedGoogle Scholar
  6. 6.
    Hafner JW Jr, Belknap SM, Squillante MD, Bucheit KA. Adverse drug events in emergency department patients. Ann Emerg Med. 2002;39:258–67.PubMedCrossRefGoogle Scholar
  7. 7.
    Sikdar KC, Alaghehbandan R, MacDonald D, Barrett B, Collins KD, Donnan J, Gadag V. Adverse drug events in adult patients leading to emergency department visits. Ann Pharmacother. 2010;44:641–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Schneitman-McIntire O, Farnen TA, Gordon N, Chan J, Toy WA. Medication misadventures resulting in emergency department visits at an HMO medical center. Am J Health-Sys Pharm. 1996;53:1416–22.Google Scholar
  9. 9.
    Malhotra S, Karan RS, Pandhi P, Jain S. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J. 2001;77:703–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Bednall R, McRobbie D, Hicks A. Identification of medication-related attendances at an A & E Department. J Clin Pharm Ther. 2003;28:41–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Hohl CM, Robitaille C, Lord V, Dankoff J, Colacone A, Pham L, et al. Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department. Acad Emerg Med. 2005;12:197–205.PubMedCrossRefGoogle Scholar
  12. 12.
    Third Consensus of Granada on Drug Therapy Problems (DRP) and Negative Outcomes associated with medication (NOM). Ars Pharm. 2007; 48: 5–17. Available at: http://farmacia.ugr.es/ars. Accessed: 12 Feb 2013.Google Scholar
  13. 13.
    Baena MI, Calleja MA, Romero JM, Vargas J, Jiménez J, Faus MJ. Validación de un cuestionario para la identificación de problemas relacionados con los medicamentos en usuarios de un servicio de urgencias hospitalario. [The validation of a questionnaire for the identification of problems arising from the use of medicines by patients at a hospital emergency ward]. Ars Pham. 2001; 42:147–161. Available at: http://farmacia.ugr.es/ars. Accessed: 12 Feb 2013.
  14. 14.
    Baena MI, Marín R, Martinez Olmos J, Fajardo P, Vargas J, Faus MJ. Nuevos criterios para determinar la evitabilidad de los problemas relacionados con los medicamentos. Una revisión actualizada a partir de la experiencia con 2.558 personas. New criteria for determining the preventability of drug-related problems. An updated review from the experience of 2,558 people. Pharm Care Esp. 2002; 4: 393–6. Available at: www.pharmaceutical-care.org. Accessed: 12 Feb 2013. Spanish.
  15. 15.
    Madurga M, de Abajo FJ, Martín-Serrano G, Montero D. El sistema Español de farmacovigilancia. [Spanish drug-surveillance system]. In: Grupo IFAS, ed. Nuevas perspectivas de la farmacovigilancia en España y en la Unión Europea. Madrid: Jarpyo editors; 1998. p. 37–62. Spanish.Google Scholar
  16. 16.
    WHOCC-ATC/DDD Index. Available at: whocc.no/atc-_ddd_index. Accessed April 2013.
  17. 17.
    Medeiros Netto A da S, Melo Barcelos de F, Silva Barros da W. Frecuencia de problemas relacionados con los medicamentos en pacientes que visitaron el servicio de urgencias de un hospital regional. [Drug-related problem frequency in patients who visited the emergency department in a regional hospital]. Seguimiento Farmacoterapéutico. 2005; 3: 213–24. Available at: www.cipf-es.org/sft. Accessed: 12 February 2013. Spanish/Portuguese.
  18. 18.
    Leendertse AJ, Egberts ACG, Stoker LJ. van den Bemt PMLA for the HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168:1890–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Tuneu L, García-Pelaez M, Lopez S, Serra G, Alba G, de Irala C, et al. Drug-related problems in patients who visit an emergency room. Pharm Care Esp. 2000; 2: 177–192. Available at: www.pharmaceutical-care.org. Accessed: 12 February 2013.Google Scholar
  20. 20.
    Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ. 2008;178:1563–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Baena MI, Faus MJ, Marin R, Zarzuelo A, Jiménez J, Martinez J. Problemas de salud relacionados con los medicamentos en un servicio de urgencias hospitalario. [Health related problems as cause of visits to hospital emergency departments]. Med Clin (Barc). 2005; 124: 250–5. Spanish.Google Scholar
  22. 22.
    Viktil KK, Bliz HS, Reikvam A, Moger TA, Hjemaas BJ, Walseth EK, et al. Comparison of drug-related problems in different patient groups. Ann Pharmacother. 2004;38:942–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Martín MT, Codina C, Tuset M, Carné X, Nogué S, Ribas J. Problemas relacionados con la medicación como causa del ingreso hospitalario. [Drug-related hospital admissions]. Med Clin (Barc). 2002; 118: 205–10. Spanish.Google Scholar
  24. 24.
    Otero-López MJ, Alonso-Hernández P, Maderuelo-Fernández JA, Ceruelo-Bermejo J, Dominguez-Gil Hurlé A, Sanchez-Rodriguez A. Prevalencia y factores asociados a los acontecimientos adversos prevenibles por medicamentos que causan el ingreso hospitalario. [Prevalence of preventable adverse drug events leading to hospital admission]. Farm Hosp. 2006; 36: 161–70. Spanish.Google Scholar
  25. 25.
    Malhotra S, Jain S, Pandhi P. Drug-related visits to the medical emergency department: a prospective study from India. Int J Clin Pharmacol Ther. 2001;39:12–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, Pirmohamend M. Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol. 2006;63:136–47.PubMedCrossRefGoogle Scholar
  27. 27.
    Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42:1017–25.PubMedCrossRefGoogle Scholar
  28. 28.
    Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2006;63:187–95.PubMedCrossRefGoogle Scholar
  29. 29.
    Peyriere H, Cassan S, Floutard E, Riviere S, Blayac JP, Hillaire-Buys D, et al. Adverse drug events associated with hospital admission. Ann Pharmacother. 2003;37:5–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Santamaría-Pablos A, Redondo-Figuero C, Baena MI, Faus MJ, Tejido R, Acha O, Novo FJ. Resultados negativos asociados con medicamentos como causa de ingreso hospitalario. [Negative results related to drugs requiring hospitalization]. Farm Hosp. 2009; 33: 12–25. Spanish.Google Scholar
  31. 31.
    Pérez Menéndez-Conde C, Bermejo Vicedo T, Delgado Silveira E, Carretero Accame E. Resultados negativos asociados al uso de medicamentos que motivan ingreso hospitalario. [Negative outcomes associated with medication which provokes hospital admission]. Farm Hosp. 2011; 35: 236–43. Spanish.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Isabel Castro
    • 1
    Email author
  • José Mª Guardiola
    • 2
  • Laura Tuneu
    • 1
  • Mª Luisa Sala
    • 1
  • Mª José Faus
    • 3
  • Mª Antonia Mangues
    • 1
  1. 1. Pharmacy DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Emergency DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
  3. 3.School of PharmacyUniversity of GranadaGranadaSpain

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