Abstract
ObjectiveTo assess medical teams’ ability to recognize adverse drug events (ADEs) in older inpatients.MethodsThe study cohort comprised 250 patients aged 65 years or older consecutively admitted to Internal Medicine wards of three hospitals in the Netherlands between April and November 2007. An independent expert team identified ADEs present upon admission or occurring during hospitalization by a structured retrospective patient chart review. For all ADEs identified, the expert team assessed causality, severity, preventability, and recognition by medical teams.ResultsThe medical teams did not recognize 19.9 % of all ADEs present upon admission {60.4 ADEs [95 % confidence interval (CI) 51.5–70.8] per 100 hospitalizations} and 20.3 % of all ADEs occurring during the hospital stay [47.2 ADEs (95 % CI 39.4–56.5) per 100 hospitalizations]. Unrecognized ADEs were significantly more often ADEs with possible causality (p=0.014, df=1), ADEs caused by medication errors (p<0.001, df=1), and ADEs not manifesting as new symptoms (p<0.001, df=1). The medical teams did not recognize 23.2 % of mild to moderately severe ADEs and 16.5 % of severe, life-threatening, or fatal ADEs. The recognition of ADEs varied with event type.ConclusionsThe recognition of ADEs by medical teams was substantial for those ADEs with evident causality and with clinically apparent and severe consequences. ADEs mimicking underlying pathologies with a lower severity went unrecognized much more often, as did those resulting only in abnormal laboratory values. Tools to improve the recognition of ADEs by medical teams should, therefore, focus on those ADEs that are more challenging to detect.
Highlights
Adverse Drug Events (ADEs) are the most frequent type of adverse events in medical inpatients [1] and are associated with a prolonged hospital stay, a twofold increase in the risk of death, and higher costs [2]
The medical teams did not recognize 19.9 % of all ADEs present upon admission {60.4 ADEs [95 % confidence interval (CI) 51.5–70.8] per 100 hospitalizations} and 20.3 % of all ADEs occurring during the hospital stay [47.2 ADEs per 100 hospitalizations]
Unrecognized ADEs were significantly more often ADEs with possible causality (p00.014, df01), ADEs caused by medication errors (p
Summary
Adverse Drug Events (ADEs) are the most frequent type of adverse events in medical inpatients [1] and are associated with a prolonged hospital stay, a twofold increase in the risk of death, and higher costs [2]. It is widely acknowledged that older patients are especially at risk for ADEs [5, 6], primarily due to multiple comorbidities, polypharmacy, and higher vulnerability due to decreased organ function, increased susceptibility to drugs, and frequently present cognitive impairment [7, 8]. Avoiding ADEs in older inpatients, and, when they do occur, timely recognition of ADEs may pose a significant challenge for medical teams [9, 10]. Failure to recognize ADEs during the hospital stay may lead to inappropriate actions causing even more harm [10]. The study by Nebeker et al [11] reports that in a general inpatient population, 24 % of ADEs subsequently identified by the researchers were not recognized by the medical teams
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