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

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 

References

  1. 1.
    Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. Jama. 1998;280(15):1311–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. Jama. 1995;274(1):29–34.CrossRefPubMedGoogle Scholar
  4. 4.
    Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163(12):1409–16.CrossRefPubMedGoogle Scholar
  5. 5.
    Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6(4):313–21.PubMedGoogle Scholar
  6. 6.
    Moore RT. Health Care Priorities for the 2007-2008 Legistlative Session. Joint Committee on Health Care Financing. 2006.Google Scholar
  7. 7.
  8. 8.
    Morimoto T, Gandhi TK, Seger AC, Hsieh TC, Bates DW. Adverse drug events and medication errors: detection and classification methods. Qual Saf Health Care. 2004;13(4):306–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10(4):199–205.CrossRefPubMedGoogle Scholar
  10. 10.
    Mann K, Rothschild JM, Keohane CA, Chu JA, Bates DW. Adverse drug events and medication errors in psychiatry: methodological issues regarding identification and classification. World J Biol Psychiatry. 2008;9(1):24–33.CrossRefPubMedGoogle Scholar
  11. 11.
    Kaushal R, Jaggi T, Walsh K, Fortescue EB, Bates DW. Pediatric medication errors: what do we know? What gaps remain? Ambul Pediatr. 2004;4(1):73–81.CrossRefPubMedGoogle Scholar
  12. 12.
  13. 13.
    Rozich JD, Haraden CR, Resar RK. Adverse drug event trigger tool: a practical methodology for measuring medication related harm. Qual Saf Health Care. 2003;12(3):194–200.CrossRefPubMedGoogle Scholar
  14. 14.
    Kilbridge PM, Campbell UC, Cozart HB, Mojarrad MG. Automated surveillance for adverse drug events at a community hospital and an academic medical center. J Am Med Inform Assoc. 2006;13(4):372–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Peterson JF, Kuperman GJ, Shek C, Patel M, Avorn J, Bates DW. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med. 2005;165(7):802–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Chertow GM, Lee J, Kuperman GJ, et al. Guided medication dosing for inpatients with renal insufficiency. Jama. 2001;286(22):2839–44.CrossRefPubMedGoogle Scholar
  17. 17.
    Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008;23(4):451–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. Jama. 1995;274(1):35–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Schiff GD, Klass D, Peterson J, Shah G, Bates DW. Linking laboratory and pharmacy: opportunities for reducing errors and improving care. Arch Intern Med. 2003;163(8):893–900.CrossRefPubMedGoogle Scholar
  20. 20.
    Hulse RK, Clark SJ, Jackson JC, Warner HR, Gardner RM. Computerized medication monitoring system. Am J Hosp Pharm. 1976;33(10):1061–4.PubMedGoogle Scholar
  21. 21.
    Kaushal R, Jha AK, Franz C, et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13(3):261–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. Jama. 1997;277(4):301–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. Jama. 1997;277(4):307–11.CrossRefPubMedGoogle Scholar
  24. 24.
    Resar RK, Rozich JD, Simmonds T, Haraden CR. A trigger tool to identify adverse events in the intensive care unit. Jt Comm J Qual Patient Saf. 2006;32(10):585–90.PubMedGoogle Scholar
  25. 25.
    Fortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003; 111(4 Pt 1):722–729.CrossRefPubMedGoogle Scholar
  26. 26.
    Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001; 285(16):2114–2120.CrossRefPubMedGoogle Scholar
  27. 27.
    Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280(15):1311–1316.CrossRefPubMedGoogle Scholar

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

Personalised recommendations