Abstract
Adverse drug reactions (ADRs) are a major cause of hospital admissions, but recent data on the incidence and clinical characteristics of ADRs which occur following hospital admission, are lacking. Patients admitted to twelve wards over a six-month period in 2005 were assessed for ADRs throughout their admission. Suspected ADRs were recorded and analysed for causality, severity and avoidability and whether they increased the length of stay. Multivariable analysis was undertaken to identify the risk factors for ADRs. The 5% significance level was used when assessing factors for inclusion in multivariable models. Out of the 3695 patient episodes assessed for ADRs, 545 (14.7%, 95% CI 13.6–15.9%) experienced one or more ADRs. Half of ADRs were definitely or possibly avoidable. The patients experiencing ADRs were more likely to be older, female, taking a larger number of medicines, and had a longer length of stay than those without ADRs. However, the only significant predictor of ADRs, from the multivariable analysis of a representative sample of patients, was the number of medicines taken by the patient with each additional medication multiplying the hazard of an ADR episode by 1.14 (95% CI 1.09, 1.20). ADRs directly increased length of stay in 147 (26.8%) patients. The drugs most frequently associated with ADRs were diuretics, opioid analgesics, and anticoagulants. In conclusion, approximately one in seven hospital in-patients experience an ADR, which is a significant cause of morbidity, increasing the length of stay of patients by an average of 0.25 days/patient admission episode. The overall burden of ADRs on hospitals is high, and effective intervention strategies are urgently needed to reduce this burden.
Highlights
Adverse drug reactions (ADRs) in hospitalised patients can be divided into two broad categories: those that cause admission to hospital, and those that occur in in-patients after hospital admission
In a study of almost 19000 admissions, we were able to show that 6.5% of patient admissions to two National Health Service (NHS) hospitals in the UK were related to an ADR [3]
We report the results of our large-scale prospective study which further explores the impact of ADRs on NHS hospital in-patients in terms of incidence, length of stay, costs involved, and factors that predispose patients to ADRs
Summary
Adverse drug reactions (ADRs) in hospitalised patients can be divided into two broad categories: those that cause admission to hospital, and those that occur in in-patients after hospital admission. In a study of almost 19000 admissions, we were able to show that 6.5% of patient admissions to two National Health Service (NHS) hospitals in the UK were related to an ADR [3]. This incidence figure is broadly compatible with pooled data from older studies [1,4], and with more recent studies [5,6]. The well-known predisposition of the elderly to ADRs, and the changes in medical practice that have occurred over the last few decades, there is a need for more data on the ADR burden in hospital in-patients
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