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International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 772–779 | Cite as

Risk of medication safety incidents with antibiotic use measured by defined daily doses

  • Anas HamadEmail author
  • Gillian Cavell
  • Paul Wade
  • James Hinton
  • Cate Whittlesea
Research Article

Abstract

Background Medication incidents (MIs) account for 11.3 % of all reported patient-safety incidents in England and Wales. Approximately one-third of inpatients are prescribed an antibiotic at some point during their hospital stay. The WHO has identified incident reporting as one solution to reduce the recurrence of adverse incidents. Objectives The aim of this study was to determine the number and nature of reported antibiotic-associated MIs occurring in inpatients and to use defined daily doses (DDDs) to calculate the incident rate for the antibiotics most commonly associated with MIs at each hospital. Setting Two UK acute NHS teaching hospitals. Methods Retrospective quantitative analysis was performed on antibiotic-associated MIs reported to the risk management system over a 2-year period. Quality-assurance measures were undertaken before analysis. The study was approved by the clinical audit departments at both hospitals. Drug consumption data from each hospital were used to calculate the DDD for each antibiotic. Main outcome measures The number of antibiotic-related MIs reported and the incident rate for the 10 antibiotics most commonly associated with MIs at each hospital. Results Healthcare staff submitted 6,756 reports, of which 885 (13.1 %) included antibiotics. This resulted in a total of 959 MIs. Most MIs occurred during prescribing (42.4 %, n = 407) and administration (40.0 %, n = 384) stages. Most common types of MIs were omission/delay (26.3 %, n = 252), and dose/frequency (17.9 %, n = 172). Penicillins (34.5 %, n = 331) and aminoglycosides (16.6 %, n = 159) were the most frequently reported groups with co-amoxiclav (16.8 %, n = 161) and gentamicin (14.1 %, n = 135) the most frequently reported drugs. Using DDDs to assess the incident rate showed that cefotaxime (105.4/10,000 DDDs), gentamicin (25.7/10,000 DDDs) and vancomycin (23.7/10,000 DDDs) had the highest rates. Conclusions This study highlights that detailed analysis of data from reports is essential in understanding MIs and developing strategies to prevent their recurrence. Using DDDs in the analysis of MIs allowed determination of an incident rate providing more useful information than the absolute numbers alone. It also highlighted the disproportionate risk associated with less commonly prescribed antibiotics not identified using MI reporting rates alone.

Keywords

Antibiotics Defined daily doses Hospital Incident reporting Medication incidents United Kingdom 

Notes

Acknowledgments

The authors appreciate the invaluable help provided by Alice Oborne in accessing the data needed from hospital B and by Moira Talpaert in calculating the DDDs at hospital A.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. However, Anas Hamad received a scholarship from Hamad Medical Corporation, Qatar, to undertake this postgraduate research.

Conflicts of interest

The authors declare that they have no conflicts of interest to disclose.

References

  1. 1.
    Williams DJP. Medication errors. J R Coll Physicians Edinb. 2007;37:343–6.Google Scholar
  2. 2.
    National Patient Safety Agency. National reporting and learning system quarterly data workbook up to December 2011. National Reporting and Learning System 2012.Google Scholar
  3. 3.
    National Patient Safety Agency (NPSA) Safe medication practice team. Safety in Doses, Medication safety incidents in the NHS. National Reporting and Learning System 2007.Google Scholar
  4. 4.
    Rothschild J, Churchill W, Erickson A, Munz K, Schuur J, Salzberg C, et al. Medication errors recovered by emergency department pharmacists. Ann Emerg Med. 2010;55(6):513–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Ross L, Wallace J, Paton J, Stephenson T. Medication errors in a paediatric teaching hospital in the UK: five years operational experience. Arch Dis Child. 2000;83:492–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Lewis P, Dornan T, Taylor D, Tully M, Wass V, Ashcroft D. Prevalence, incidence and nature of prescribing errors in hospital inpatients, a systematic review. Drug Saf. 2009;32(5):379–89.PubMedCrossRefGoogle Scholar
  7. 7.
    Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, et al. Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ. 2009;338:b814.PubMedCrossRefGoogle Scholar
  8. 8.
    Leape L, Abookire S. WHO draft guidelines for adverse event reporting and learning systems: From information to action. Geneva: WHO World Alliance for Patient Safety; 2005.Google Scholar
  9. 9.
    Dean B, Lawson W, Jacklin A, Rogers T, Azadian B, Holmes A. The use of serial point prevalence studies to investigate antiinfective prescribing. Int J Pharm Pract. 2002;10:121–5.CrossRefGoogle Scholar
  10. 10.
    National Patient Safety Agency (NPSA) Safe medication practice team. Safety in Doses, Improving the use of medicines in the NHS. National Reporting and Learning System 2009.Google Scholar
  11. 11.
    WHO Collaborating Centre for Drug Statistics Methodology and Norwegian Institute of Public Health. http://www.whocc.no/ddd/definition_and_general_considera. Accessed 17 August 2011.
  12. 12.
    Monnet DL. ABC Calc.—Antibiotic Consumption Calculator [Microsoft® Excel application]. Version 3.1. Copenhagen (Denmark): Statens Serum Institut; 2006.Google Scholar
  13. 13.
    Ashcroft D, Cooke J. Retrospective analysis of medication incidents reported using an on-line reporting system. Pharm World Sci. 2006;28:359–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Picone D, Titler M, Dochterman J, Shever L, Kim T, Abramowitz P, et al. Predictors of medication errors among elderly hospitalized patients. Am J Med Qual. 2008;23(2):115–27.PubMedCrossRefGoogle Scholar
  15. 15.
    National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR009: Reducing harm from omitted and delayed medicines in hospital: Supporting Information. National Reporting and Learning System 2010.Google Scholar
  16. 16.
    Thomas M, Schultz T, Hannaford N, Runciman W. Mapping the limits of safety reporting systems in health care–what lessons can we actually learn? Med J Aust. 2011;194(12):635–9.PubMedGoogle Scholar
  17. 17.
    National Patient Safety Agency. Review of patient safety in children and young people. National Reporting and Learning System 2009.Google Scholar
  18. 18.
    Alrwisan A, Ross J, Williams D. Medication incidents reported to an online incident reporting system. Eur J Clin Pharmacol. 2011;67:527–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Kingston M, Evans S, Smith B, Berry J. Attitudes of doctors and nurses towards incident reporting: a qualitative analysis. Med J Aust. 2004;181(1):36–9.PubMedGoogle Scholar
  20. 20.
    Gavaza P, Brown C, Lawson K, Rascati K, Wilson J, Steinhardt M. Influence of attitudes on pharmacists’ intention to report serious adverse drug events to the food and drug administration. Br J Clin Pharmacol. 2011;72(1):143–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Olsen S, Neale G, Schwab K, Psaila B, Patel T, Chapman E, et al. Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place. Qual Saf Health Care. 2007;16:40–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Cullen D, Bates D, Small S, Cooper J, Nemeskal A, Leape L. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv. 1995;21(10):541–8.PubMedGoogle Scholar
  23. 23.
    Field T, Gurwitz J, Harrold L, Rothschild J, Debellis K, Seger A, et al. Strategies for detecting adverse drug events among older persons in the ambulatory setting. J Am Med Inform Assoc. 2004;11(6):492–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Ghaleb M, Barber N, Franklin B, Wong I. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010;95(2):113–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Mahajan RP. Critical incident reporting and learning. Br J Anaesth. 2010;105(1):69–75.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Anas Hamad
    • 3
    Email author
  • Gillian Cavell
    • 1
  • Paul Wade
    • 2
  • James Hinton
    • 1
  • Cate Whittlesea
    • 3
  1. 1.King’s College London, King’s Health Partners, Pharmaceutical Science Clinical Academic GroupKing’s College Hospital NHS Foundation TrustLondonUK
  2. 2.King’s College London, King’s Health Partners, Pharmaceutical Science Clinical Academic GroupGuy’s and St Thomas’ NHS Foundation TrustLondonUK
  3. 3.King’s College London, King’s Health Partners, Pharmaceutical Science Clinical Academic GroupInstitute of Pharmaceutical ScienceLondonUK

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