Abstract
BackgroundKnowledge of the epidemiology of adverse drug events (ADEs) and medication errors in psychiatric inpatients is limited outside Western countries. The nature of ADEs and medication errors are important for improving the quality of care worldwide; therefore, we conducted the Japan Adverse Drug Events Study, a series of cohort studies at several settings in Japan.MethodsThis report included 448 inpatients with 22,733 patient-days in a psychiatric hospital and psychiatric units at a tertiary care teaching hospital over 1 year. Four psychiatrists and two other physicians reviewed all medical charts and related documents to identify suspected incidents. The physicians later classified those incidents into ADEs, potential ADEs, medication errors, or exclusions and evaluated the severity and preventability if the incidents were events.ResultsDuring the study period, we identified 955 ADEs and 398 medication errors (incidence: 42.0 and 17.5 per 1000 patient-days, respectively). Among ADEs, 1.4 %, 28 %, and 71 % were life-threatening, serious, and significant, respectively. Antipsychotics were associated with half of all ADEs. The incidence of medication errors was higher in medical care units than in acute and nursing care units (40.9, 15.6, and 17.4 per 1000 patient-days, respectively). The monitoring and ordering stages were the most common error stages (39 % and 34 % of all medication errors, respectively), and 76 % of medication errors with ADEs were found at the monitoring stage. Non-psychiatric drugs were three times as likely to cause ADEs with errors compared to psychiatric drugs.ConclusionsAntipsychotic use, inadequate monitoring, and treatment of physical ailments by psychiatrists may contribute to the high incidence of medication errors and ADEs among psychiatric inpatients in Japan. Psychiatrists should be cautious in prescribing antipsychotics or unfamiliar medications for physical problems in their psychiatric patients, and should monitor patients after medication administration.
Highlights
Knowledge of the epidemiology of adverse drug events (ADEs) and medication errors in psychiatric inpatients is limited outside Western countries
ADEs were observed in 63 % of psychiatric inpatients with an incidence of 42 per 1000 patient-days, and medication errors were observed in 39 % of inpatients with an incidence of 17.5 per 1000 patient-days
95 % Confidence interval (CI) 16.4–34.1 17.5–83.8 35.9–227 25.8–48.3 we identified frequent medication errors at the monitoring stage (39 % of all medication errors), and this was more evident for preventable ADEs (76 % of all preventable ADEs occurred at this stage)
Summary
Knowledge of the epidemiology of adverse drug events (ADEs) and medication errors in psychiatric inpatients is limited outside Western countries. Longer hospital stays and lower staff ratios are two characteristics of Japanese psychiatric care [15], while many African countries suffer from a critical lack of psychiatrists and pharmacists [16]. To this end, we conducted a historical cohort study in psychiatric settings to estimate the incidence and nature of ADEs and medication errors among psychiatric inpatients in Japan
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