Drug-Related Hospitalizations in a Tertiary Care Internal Medicine Service of a Canadian Hospital: A Prospective Study
Ms. Leslie Jo Samoy B.Sc.(Pharm.)
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
Search for more papers by this authorCorresponding Author
Dr. Peter J. Zed Pharm.D., FCSHP, B.Sc., B.Sc.(Pharm.)
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
Departments of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
Faculties of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, British Columbia, Canada V5Z 1M9; e-mail: [email protected].Search for more papers by this authorDr. Kerry Wilbur Pharm.D.
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
Faculties of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorDr. Robert M. Balen Pharm.D.
Department of Pharmacy, Royal Columbian Hospital, New Westminster, British Columbia, Canada
Faculties of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorDr. Riyad B. Abu-Laban M.D., M.H.Sc., FRCPC
Departments of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
Search for more papers by this authorDr. Mark Roberts M.D., FRCPC
Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorMs. Leslie Jo Samoy B.Sc.(Pharm.)
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
Search for more papers by this authorCorresponding Author
Dr. Peter J. Zed Pharm.D., FCSHP, B.Sc., B.Sc.(Pharm.)
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
Departments of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
Faculties of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, British Columbia, Canada V5Z 1M9; e-mail: [email protected].Search for more papers by this authorDr. Kerry Wilbur Pharm.D.
Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
Faculties of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorDr. Robert M. Balen Pharm.D.
Department of Pharmacy, Royal Columbian Hospital, New Westminster, British Columbia, Canada
Faculties of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorDr. Riyad B. Abu-Laban M.D., M.H.Sc., FRCPC
Departments of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
Search for more papers by this authorDr. Mark Roberts M.D., FRCPC
Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorAbstract
Study Objectives. To determine the frequency, severity, preventability and classification of adverse drug events resulting in hospitalization, and to identify any patient, prescriber, drug, and system factors associated with these events.
Design. Prospective, observational study.
Setting. Internal medicine service of a large tertiary care hospital in Canada.
Patients. A total of 565 consecutive adult patients admitted to the hospital during a 12-week period.
Measurements and Main Results. A patient's hospitalization was defined as drug related if it was directly related to one of eight predefined classifications; severity and preventability of the hospitalization were also assessed. Multivariate logistic regression analysis was used to evaluate patient, prescriber, drug, and system factors associated with drug-related hospitalizations. The frequency of drug-related hospitalization was 24.1% (95% confidence interval [CI] 20.6–27.8%), of which 72.1% (95% CI 63.7–79.4%) were deemed preventable. Severity was classified as mild, moderate, severe, and fatal in 8.1% (95% CI 4.1–14.0%), 83.8% (95% CI 76.5–89.6%), 7.4% (95% CI 3.6–13.1%), and 0.7% (95% CI 0.0–4.0%), respectively, of the hospitalizations. The most common classifications of drug-related hospitalization were adverse drug reactions (35.3% [95% CI 27.3–43.9%]), improper drug selection (17.6% [95% CI 11.6–25.1%]), and noncompliance (16.2% [95% CI 10.4–23.5%]). No independent risk factors for drug-related hospitalization were identified with regression modeling.
Conclusion. Approximately 25% of patients in our study were hospitalized for drug-related causes; over 70% of these causes were deemed preventable. Drug-related hospitalization is a significant problem that merits further research and intervention.
References
- 1 Nebeker, J.R., Barach, P., Samore, M.H.. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med 2004; 140: 795–801.
- 2 Tafreshi, M.J., Melby, M.J., Kaback, K.R., Nord, T.C.. Medication-related visits to the emergency department: a prospective study. Ann Pharmacother 1999; 33: 1252–7.
- 3 Gandhi, T.K., Weingart, S.N., Borus, J., et al. Adverse drug events in ambulatory care. N Engl J Med 2003; 348: 1556–64.
- 4 Bates, D.W., Spell, N., Cullen, D.J., et al. The costs of adverse events in hospitalized patients. JAMA 1997; 277: 307–11.
- 5 Johnson, J.A., Bootman, J.L.. Drug-related morbidity and mortality: a cost of illness model. Arch Intern Med 1995; 155: 1949–56.
- 6 Ernst, F.R., Grizzle, A.J.. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc 2001; 41: 192–9.
- 7 Gurwitz, J.H., Field, T.S., Harrold, L.R., et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289: 1107–16.
- 8 Einarson, T.R.. Drug-related hospital admissions. Ann Pharmacother 1993; 27: 832–40.
- 9 Bates, D.W., Cullen, D.J., Laird, N., et al. Incidence of adverse drug events and potential adverse drug events. JAMA 1995; 274: 29–34.
- 10 Nelson, K.M., Talbert, R.L.. Drug-related hospital admissions. Pharmacotherapy 1996; 16: 701–7.
- 11 Classen, D.C., Pestotnik, S.L., Evans, R.S., et al. Adverse drug events in hospitalized patients: excess length of stay, extra costs and attributable mortality. JAMA 1997; 277: 301–6.
- 12 Lazarou, J., Pomeranz, B.H., Corey, P.N.. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279: 1200–6.
- 13 Lagnaoui, R., Moore, N., Fach, J., et al. Adverse drug reactions in a department of systemic disease-oriented internal medicine: prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol 2000; 56: 181–6.
- 14 McDonnell, P.J., Jacobs, M.R.. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 2002; 36: 1331–6.
- 15 Winterstein, A.G., Thomas, E.J., Rosenberg, E.I., et al. Nature and causes of clinically significant medication errors in a tertiary care hospital. Am J Health-Syst Pharm 2004; 61: 1908–16.
- 16 Peyriere, H., Cassan, S., Floutard, E., et al. Adverse drug events associated with hospital admission. Ann Pharmacother 2003; 37: 5–10.
- 17 Pirmohamed, M., James, S., Meakin, S., et al. Adverse drug reactions as a cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 2004; 329: 15–19.
- 18 Baker, G.R., Norton, P.G., Flintoft, V., et al. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. Can Med Assoc J 2004; 170: 1678–86.
- 19
Zed, P.J..
Drug-related visits to the emergency department.
J Pharm Pract
2005; 18: 329–35.
10.1177/0897190005280049 Google Scholar
- 20 Patel, P., Zed, P.J.. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy 2002; 22: 915–23.
- 21 Prince, B.S., Goetz, C.M., Rihn, T.L., Olsk, M.. Drug-related emergency department visits and hospital admissions. Am J Hosp Pharm 1992; 49: 1696–700.
- 22 Stoukides, C.A., D'Agostino, P.R., Kaufman, M.B.. Adverse drug reaction surveillance in an emergency room. Am J Hosp Pharm 1993; 50: 712–14.
- 23 Dennehy, C.E., Kishi, D.T., Louie, C.. Drug-related illness in emergency department patients. Am J Health Syst Pharm 1996; 53: 1422–6.
- 24 Schneitman-McIntire, O., Farnen, T.A., Gordon, N., et al. Medication misadventures resulting in emergency department visits at an HMO medical center. Am J Health-Syst Pharm 1996; 53: 1416–22.
- 25 Smith, K.M., McAdams, W., Frenia, M.L., Todd, M.W.. Drug-related problems in emergency department patients. Am J Health-Syst Pharm 1997; 54: 295–8.
- 26 Aparasu, R.R.. Drug-related-injury visits to hospital emergency departments. Am J Health-Syst Pharm 1998; 55: 1158–61.
- 27 Aparasu, R.R., Helgeland, D.L.. Visits to hospital outpatient departments in the United States due to adverse effects of medications. Hosp Pharm 2000; 35: 825–31.
- 28 Hohl, C.M., Dankoff, J., Colacone, A., Afilalo, M.. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001; 38: 666–71.
- 29 Hafner, J.W., Belknap, S.M., Squillante, M.D., Bucheit, K.A.. Adverse drug events in emergency department patients. Ann Emerg Med 2002; 39: 258–67.
- 30 Raschetti, R., Morgutti, M., Menniti-Ippolito, F., et al. Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol 1999; 54: 959–63.
- 31 Olshaker, J.S., Barish, R.A., Naradzay, J.F., et al. Prescription noncompliance: contribution to emergency department visits and cost. J Emerg Med 1999; 17: 909–12.
- 32 Malhotra, S., Karan, R.S., Pandhi, P., Jain, S.. Drug-related medical emergencies in the elderly: role of adverse reaction and noncompliance. Postgrad Med J 2001; 77: 703–7.
- 33 Bannwarth, B., Queneau, P., Carpentier, F., et al. Hospital visits caused by adverse drug reactions: incidence and preventability assessed in French primary care/emergency departments. Drug Saf 2003; 26: 133–4.
- 34 World Health Organization. International drug monitoring: the role of the hospital. Technical report series no. 425. Geneva, Switzerland: World Health Organization, 1966: 1–24.
- 35 Hepler, C.D., Strand, L.M.. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990; 47: 533–43.
- 36 Hepler, C.D.. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Pharmacotherapy 2004; 24: 1491–8.
- 37 R.J. Cipolle, L.M. Strand, P.C. Morley, eds. Pharmaceutical care practice: the clinician's guide, 2nd ed. New York: McGraw-Hill, 2004.
- 38 van Mil, Foppe J.W., Westerlund, L.T., Hersberger, K.E., Schaefer, M.A.. Drug-related problem classification systems. Ann Pharmacother 2004; 38: 859–67.
- 39 Forster, A.J., Shojania, K.G., van Walraven, C.. Improving patient safety: moving beyond the “hype” of medical errors. Can Med Assoc J 2005; 173: 893–4.
- 40 Government of British Columbia Ministry of Health. PharmaNet: province-wide network that links all BC pharmacies to a central set of data systems. Available from http:www.healthservices.gov.bc.capharmepharmanetnetindex.html. Accessed May 28, 2006.
- 41 Forster, A.J., Clark, H.D., Menard, A., et al. Adverse events among medical patients after discharge from hospital. Can Med Assoc J 2004; 170: 345–9.
- 42 Hallas, J., Harvald, B., Gram, L.F., et al. Drug related hospital admissions: the role of definitions and intensity of data collection and the possibility of prevention. J Intern Med 1990; 228: 83–90.
- 43 McKenny, J.M., Harrison, W.L.. Drug-related hospital admissions. Am J Hosp Pharm 1976; 33: 792–5.
- 44 Bhalla, N., Duggan, C., Dhillon, S.. The incidence and nature of drug-related admissions to the hospital. Pharm J 2003; 270: 583–6.
- 45 Grymonpre, R.E., Mitenko, P.A., Sitar, D.S., et al. Drug-associated hospital admissions in older medical patients. J Am Geriatr Soc 1988; 36: 1092–8.
- 46 Hohl, C.M., Robitaille, C., Lord, V., 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.
- 47 Cornish, P.L., Knowles, S.R., Marchesano, R., et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005; 165: 434–9.
- 48 Evans, R.S., Lloyd, J.F., Stoddard, G.J., et al. Risk of adverse drug events: a 10-year analysis. Ann Pharmacother 2005; 39: 1161–8.
- 49 Fialova, D., Topinkova, E., Gambassi, G., et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 2005; 293: 1348–58.
- 50 Haynes, R.B., McDonald, H.P., Garg, A.X.. Helping patients follow prescribed treatment: clinical applications. JAMA 2002; 288: 2880–3.
- 51 Ostertag, L., Blaschke, T.. Adherence to medication. N Engl J Med 2005; 353: 487–97.
- 52 Naranjo, C.A., Busto, U., Sellers, E.M., et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–45.
