Journal of General Internal Medicine

, Volume 25, Issue 1, pp 31–38 | Cite as

Adverse Drug Event Rates in Six Community Hospitals and the Potential Impact of Computerized Physician Order Entry for Prevention

  • Balthasar L. Hug
  • Daniel J. Witkowski
  • Colin M. Sox
  • Carol A. Keohane
  • Diane L. Seger
  • Catherine Yoon
  • Michael E. Matheny
  • David W. Bates
Hospital Medicine
First Online:
Received:
Revised:
Accepted:

Abstract

CONTEXT

Medications represent a major cause of harm and are costly for hospitalized patients, but more is known about these issues in large academic hospitals than in smaller hospitals.

OBJECTIVE

To assess the incidence of adverse drug events (ADEs) in six community hospitals.

DESIGN

Multicenter, retrospective cohort study.

SETTING

Six Massachusetts community hospitals with 100 to 300 beds.

PATIENTS

From 109,641 adult patients hospitalized from January 2005 through August 2006, a random sample of 1,200 patients was drawn, 200 per site.

MAIN OUTCOME MEASURES

ADEs and preventable ADEs.

METHODS

Presence of an ADE was evaluated using an adaptation of a trigger instrument developed by the Institute for Health Care Improvement. Independent reviewers classified events by preventability, severity, and potential for preventability by computerized physician order entry (CPOE).

RESULTS

A total of 180 ADEs occurred in 141 patients (rate, 15.0/100 admissions). Overall, 75% were preventable. ADEs were rated as serious in 49.4% and life threatening in 11.7%. Patients with ADEs were older (mean age, 74.6 years, p < 0.001), more often female (60.3%, p = 0.61), and more often Caucasian (96.5%, p < 0.001) than patients without ADEs. Of the preventable ADEs, 81.5% were judged potentially preventable by CPOE.

CONCLUSIONS

The incidence of ADEs in these community hospital admissions was high, and most ADEs were preventable, mostly through CPOE. These data suggest that CPOE may be beneficial in this setting.

KEY WORDS

drug safety adverse drug events potential adverse drug event computerized physician order entry community hospital Massachusetts 
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Notes

Acknowledgements

We thank Jason Lee, research assistant, for building the Access Database and the study nurses, Kris Martel-Waldrop, Cathy Foskett, Mary-Clare Hickey, Theresa McNeil, and Martha Vander Vliet, all RNs, for collecting data at the multiple study sites.

Conflict of Interest Disclosure Statements

The Massachusetts Technology Collaborative supported the study. They commented on its design, but were not involved in collection, management, analysis, or interpretation of the data. They did approve the manuscript. Dr. Bates had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Bates is a co-inventor on Patent No. 6029138 held by Brigham and Women’s Hospital on the use of decision support software for medical management, licensed to the Medicalis Corporation. He holds a minority equity position in the privately held company Medicalis, which develops web-based decision support for radiology test ordering, and serves as a consultant to Medicalis. He is a consultant for Cardinal Health, which makes intravenous drug delivery systems. Dr. Hug has received financial funding from the Freie Akademische Gesellschaft, the Walter and Margarethe Lichtenstein Fund, and the University Hospital in Basel, Switzerland.

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Balthasar L. Hug
    • 1
  • Daniel J. Witkowski
    • 2
  • Colin M. Sox
    • 3
  • Carol A. Keohane
    • 1
  • Diane L. Seger
    • 1
  • Catherine Yoon
    • 1
  • Michael E. Matheny
    • 1
    • 4
  • David W. Bates
    • 1
  1. 1.Division of General Internal MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Women’s Healthcare Associates, P.C.MelroseUSA
  3. 3.Center for Child Health Care Studies, Department of Ambulatory Care and PreventionHarvard Medical School and Harvard Pilgrim Health CareBostonUSA
  4. 4.Decision Systems GroupBrigham and Women’s HospitalBostonUSA

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