Avoidable Adverse Drug Events Research Articles

The NASEM Report: Are the Solutions Part of the Problem?

The NASEM Report: Are the Solutions Part of the Problem?

POSB235 Effectiveness and Cost-Effectiveness of a Collaborative Deprescribing Intervention of Proton-Pump Inhibitors on Community-Dwelling Elderly (C-SENIOR Trial): A Study Protocol

Medication safety for elderly people is an ongoing challenge. Older people are often exposed to unnecessary or inappropriate medications – medicines with a high risk of harm. There is evidence that inappropriate medications are overprescribed, accounting for a significant proportion of avoidable adverse drug events, emergency department visits and hospitalizations. This study aims to present the protocol of a study to investigate the effectiveness and cost-effectiveness of a community pharmacist-general practitioner collaborative deprescribing intervention of potential inappropriate class of medicines, focusing proton-pump inhibitors, among the community dwelling elderly.

Evaluation of the Direct Costs of Managing Adverse Drug Events in all Ages and of Avoidable Adverse Drug Events in Older Adults in Japan.

In Japan, medical costs are increasing annually, and the increase in national medical costs, particularly in the direct cost of managing adverse drug events, is high. An in-depth understanding of these costs is important for their reduction. This study aimed to calculate the direct cost of managing adverse drug events in all ages, including older adults, and that of avoidable adverse drug events in older adults. We conducted a retrospective survey on patients aged 1 year or older who visited Gifu Municipal Hospital in Japan. We investigated and calculated the direct cost of managing adverse drug events and that of avoidable adverse drug events based on the Beers Criteria Japanese version (BCJ) and “Guidelines for medical treatment and its safety in the elderly 2015” (GMTSE-2015) in inpatients and outpatients. Among 6,504 patients, 11.1% visited the hospital or were hospitalized due to adverse drug events. The direct costs per patient with adverse drug events were 21,281 and 22,590 yen (166 and 176 euros as on September 13, 2021) for outpatients, and 853,175 and 874,582 yen (6,648 and 6,815 euros) for inpatients of all ages and older adults, respectively. The direct costs of avoidable adverse drug events per patient using drugs listed in the BCJ and GMTSE-2015 for older adults were 3,212 and 3,341 yen (25 and 26 euros) for outpatients, and 55,548 and 80,246 yen (433 and 625 euros) for inpatients, respectively. In sum, considering both inpatients and outpatients in the whole country, the direct costs of managing adverse drug events were 804.53 billion and 597.19 billion yen (6,269 million and 4,653 million euros) per year for all ages and older ages, respectively. The direct cost of avoidable adverse drug events in older adults was 83.43–258.44 billion yen (650–2,013 million euros) per year. We found that, in Japan, high medical costs are often caused by managing adverse drug events, and that the costs of avoidable adverse drug events in older adults based on the BCJ and GMTSE-2015 account for a substantial proportion of the medical cost. Therefore, by using the BCJ and GMTSE-2015, avoiding adverse drug events and reducing medical costs may be possible.

Prevalence and predictors of potentially inappropriate prescribing in middle-aged adults: a repeated cross-sectional study.

BackgroundPotentially inappropriate prescribing (PIP) is common in older adults and known to be associated with polypharmacy and multimorbidity. Less is known about the prevalence and causes of PIP in middle-aged adults.AimTo determine the prevalence and predictors of PIP in middle-aged adults.Design and settingA repeated cross-sectional study was conducted using primary care data in London.MethodPIP was defined using the PRescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria. Prescribing and demographic data were extracted from Lambeth DataNet (LDN), a pseudonymised database of all patients registered at general practices in Lambeth, for those aged 45–64 years prescribed ≥1 medicines in each year from 2014–2019 (n = 46 633–52 582). Prevalence and trends over 6 years were investigated, including the association of PIP with polypharmacy, multimorbidity, deprivation, sex, and age.ResultsThe prevalence of PIP decreased from 20% in 2014 to 18% in 2019. The most prevalent PROMPT criteria in 2019 were the use of ≥2 drugs from the same pharmacological class (7.6%), use of non-steroidal anti-inflammatory drugs for >3 months (7.1%) and use of proton pump inhibitors above recommended maintenance dosages for >8 weeks (3.1%). Over the study period, the prevalence of multimorbidity increased (47–52%) and polypharmacy remained stable (27%). Polypharmacy, multimorbidity, deprivation, and age were independently associated with PIP. Sex was the only variable not associated with PIP.ConclusionAlmost one-fifth of middle-aged adults prescribed medicines are exposed to PIP, as defined by the PROMPT criteria. This is likely to be linked with exposure to avoidable adverse drug events. The PROMPT criteria may provide a useful aid in interventions to optimise prescribing.

Economic analysis of the prevalence and clinical and economic burden of medication error in England

ObjectivesTo provide national estimates of the number and clinical and economic burden of medication errors in the National Health Service (NHS) in England.MethodsWe used UK-based prevalence of medication errors (in...

A Modern Method to Monitor Office Blood Pressure

The diagnosis and management of hypertension relies on accurate and precise blood pressure (BP) measurements and monitoring techniques. Variability in traditional office based BP readings can contribute to misclassification and potential misdiagnosis of hypertension, leading to inappropriate treatment and possibly avoidable adverse drug events. Both home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) can improve characterization of BP status over traditional office values and can predict cardiovascular morbidity and mortality risk; however, they are limited by availability and/or practical use in many situations. Available in-office blood pressure measuring methods include manual auscultation, automated oscillometric, and automated office blood pressure (AOBP) devices. A strong correlation exists between AOBP and awake ABPM measurements and has been linked to better prediction of end-organ damage and white coat response compared to standard office BP methods. While AOBP does not provide nocturnal BP readings, it can be utilized in several outpatient settings, and has the capability to decrease utilization of ABPM, white coat effect, and improve optimization of cardiovascular assessment, evaluation, and therapeutic assessment in clinical practice.
 Hypertension affects over 80 million adults in the United States (US) and is a major risk factor for cardiovascular morbidity and mortality [1]. The condition’s ubiquitous nature and broad impact potentially makes understanding the diagnosis and treatment of hypertension key elements of managing cardiovascular risk. Though much attention is paid to the treatment of hypertension, from 2009 to 2012, 45.9% of US patients with hypertension were uncontrolled [1]. Appreciating the aspects of proper assessment of blood pressure is crucial and creates the foundation for approaching hypertension management. Until recently, hypertension was defined as an appropriately measured office systolic blood pressure (SBP) of greater than or equal to 140 mmHg and/or diastolic blood pressure (DBP) greater than or equal to 90 mmHg, with the patient seated and resting for 5 minutes in a proper position, and preferentially, measured as an average of two readings taken 1 or 2 minutes apart [1-5]. While serving as the primary method, standard office blood pressure assessment with either manual or traditional automated BP cuffs is limited in accuracy and application in everyday practice, and faces many challenges. As such, an understanding of the potential limitations of current BP strategies, and the roles and rationale for novel assessment techniques are of value to clinicians [6].
 Conflict of Interest: We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.
 
 Type: Review

Potentially Inappropriate Antidepressant Prescriptions Among Older Adults in Office-Based Outpatient Settings: National Trends from 2002 to 2012.

Using data from 2002 to 2012 National Ambulatory Medical Care Survey, we estimated that the prevalence of overall antidepressant prescriptions increased almost twofold from 5.2% in 2002 to 10.1% in 2012 in office-based outpatient visits made by older adults. In addition, older adults were exposed to the risk of potentially avoidable adverse drug events in approximately one in ten antidepressant-related visits, or 2.2million visits annually. Amitriptyline and doxepin were the two most frequent disease-independent potentially inappropriate antidepressants. Racial/ethnic minorities, and Medicaid beneficiaries had higher odds of potentially inappropriate antidepressant prescriptions (P < 0.05). Efforts to minimize potentially inappropriate antidepressant prescriptions are needed.

Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward

Potentially inappropriate prescribing in healthcare of the elderly (HCE) is associated with avoidable adverse drug events (ADEs).1,2 A recent set of prescribing criteria has been designed and validated, called “Screening...

Application of STOPP Criteria and Beers Criteria in an inpatient psychiatric facility and impact on utilization of potentially inappropriate medications and adverse outcomes

Background: The Beers Criteria and STOPP Criteria were developed to identify potentially inappropriate medications (PIMs) in the geriatric population. Utilization of STOPP Criteria PIMs have shown a significant association with presence of avoidable adverse drug events (ADEs) as compared to utilization of Beers Criteria PIMs. Objectives: The purpose of this study was to utilize STOPP and Beers Criteria to identify PIMs in geriatric patients at an inpatient psychiatric facility, with the goal of implementing a formal process for assessing medication regimens. This process would be expected to decrease adverse outcomes. Methods: Both criteria were used by the pharmacist to identify PIMs and recommendations were made to address the PIMs. A retrospective chart review evaluated whether utilization of the two criteria led to a significant change in number of PIMs and associated adverse outcomes. The primary outcome was the change in number of PIMs for the Beers Criteria versus the STOPP Criteria. Secondary outcomes included the change in number of PIMs, falls, required referrals/transfers, and medication-specific ADEs for each set of criteria assessed separately. Results: Twenty-nine patients met inclusion criteria, and 76 treatment recommendations were made. More PIMs per patient were identified at baseline utilizing STOPP (mean±SD,3.9±2.3) versus Beers Criteria (mean±SD, 2.2±1.3) (p&amp;lt;0.001). The number of PIMs decreased using STOPP (from 112 to 66; mean decrease per patient −1.6±1.5, p&amp;lt;0.0001) and Beers Criteria (from 63 to 23; mean decrease per patient −1.4±1.1, p&amp;lt;0.0001), although the change was not significant for STOPP vs. Beers (p=0.375). All secondary outcomes decreased using both criteria. Conclusions: Utilization of each set of criteria by the pharmacist led to a significant decrease in PIMs and adverse outcomes decreased at follow-up using both criteria. Implementation of a process for assessing medication regimens of geriatric patients utilizing the Beers and/or STOPP Criteria would likely be beneficial to this institution.

Comparison Between Beers Criteria and Screening Tool of Older Person's Prescriptions as a Screening Tool for the Detection of Potentially Inappropriate Medicines and Adverse Drug Events in the Elderly Patients

Background: Beers criteria are used to identify the potentially inappropriate medications (PIMs) in elderly patients. However, the criteria have limitations such as lacking consideration of drug-drug and duplicated prescriptions. The aim of this study is to compare the efficacy of newly developed screening tool of older person's prescriptions (STOPP) with Beers criteria in identifying PIMs and adverse drug events (ADEs) in elderly patients. Methods: We included 115 elderly patients older than 65 years who visited the outpatients’ clinic or have been hospitalized for medical illness. Comprehensive geriatric assessments including medication review by the pharmacists were performed by the multidisciplinary team. Beers criteria and STOPP were used to find out PIMs. The association between PIMs defined by both criteria with ADEs was also evaluated. Results: A total of 59 patients (50.4%) by Beers criteria and 76 patients (65.0%) by STOPP had been prescribed with PIMs. Compared with Beers criteria, STOPP had advantage in identifying more PIMs. In addition, STOPP could identify more ADEs related medications than Beers criteria. STOPP was also useful to detect duplicate drug class prescription and nonsteroidal anti-inflammatory drugs for renal impaired patients. Conclusion: STOPP criteria PIMs can detect more duplicated prescription and are significantly associated with avoidable ADEs in older individuals compared with that of Beers criteria PIMs.

GRP-119 Most Frequent Drug-Related Events Detected by Pharmaceutical Analysis of Computerized Physician Order Entry and Proposed Solutions

BackgroundIn 2012, Toulouse University hospital implemented a Computerized Physician Order Entry (CPOE) system in two digestive surgery departments (41 inpatient beds). Clinical pharmacists in the wards contribute to safeguarding the...

Medication errors – new approaches to prevention

Medication errors in pediatric anesthesia represent an important risk to children. Concerted action to reduce harm from this cause is overdue. An understanding of the genesis of avoidable adverse drug events may facilitate the development of effective countermeasures to the events or their effects. Errors include those involving the automatic system of cognition and those involving the reflective system. Errors and violations are distinct, but violations often predispose to error. The system of medication administration is complex, and many aspects of it are conducive to error. Evidence-based practices to reduce the risk of medication error in general include those encompassed by the following recommendations: systematic countermeasures should be used to decrease the number of drug administration errors in anesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimized according to agreed standards; syringes should always be labeled; formal organization of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered. Dosage errors are particularly common in pediatric patients. Causes that should be addressed include a lack of pediatric formulations and/or presentations of medication that necessitates dilution before administration or the use of intravenous formulations for oral administration in children, a frequent failure to obtain accurate weights for patients and a paucity of pharmacokinetic and pharmacodynamic data. Technological innovations, including the use of bar codes and various cognitive aids, may facilitate compliance with these recommendations. Improved medication safety requires a system-wide strategy standardized at least to the level of the institution; it is the responsibility of institutional leadership to introduce such strategies and of individual practitioners to engage in them.

Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients

Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness. We prospectively studied 600 consecutive patients 65 years or older who were admitted with acute illness to a university teaching hospital over a 4-month interval. Potentially inappropriate medicines were defined by both Beers and STOPP criteria. Adverse drug events were defined by World Health Organization-Uppsala Monitoring Centre criteria and verified by a local expert consensus panel, which also assessed whether ADEs were causal or contributory to current hospitalization. Hallas criteria defined ADE avoidability. We compared the proportions of patients taking Beers criteria PIMs and STOPP criteria PIMs with avoidable ADEs that were causal or contributory to admission. A total of 329 ADEs were detected in 158 of 600 patients (26.3%); 219 of 329 ADEs (66.6%) were considered causal or contributory to admission. Of the 219 ADEs, 151 (68.9%) considered causal or contributory to admission were avoidable or potentially avoidable. After adjusting for age, sex, comorbidity, dementia, baseline activities of daily living function, and number of medications, the likelihood of a serious avoidable ADE increased significantly when STOPP PIMs were prescribed (odds ratio, 1.847; 95% confidence interval [CI], 1.506-2.264; P < .001); prescription of Beers criteria PIMs did not significantly increase ADE risk (odds ratio, 1.276; 95% CI, 0.945-1.722; P = .11). STOPP criteria PIMs, unlike Beers criteria PIMs, are significantly associated with avoidable ADEs in older people that cause or contribute to urgent hospitalization.

Medication errors – new approaches to prevention

Medication errors in pediatric anesthesia represent an important risk to children. Concerted action to reduce harm from this cause is overdue. An understanding of the genesis of avoidable adverse drug events may facilitate the development of effective countermeasures to the events or their effects. Errors include those involving the automatic system of cognition and those involving the reflective system. Errors and violations are distinct, but violations often predispose to error. The system of medication administration is complex, and many aspects of it are conducive to error. Evidence-based practices to reduce the risk of medication error in general include those encompassed by the following recommendations: systematic countermeasures should be used to decrease the number of drug administration errors in anesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimized according to agreed standards; syringes should always be labeled; formal organization of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered. Dosage errors are particularly common in pediatric patients. Causes that should be addressed include a lack of pediatric formulations and/or presentations of medication that necessitates dilution before administration or the use of intravenous formulations for oral administration in children, a frequent failure to obtain accurate weights for patients and a paucity of pharmacokinetic and pharmacodynamic data. Technological innovations, including the use of bar codes and various cognitive aids, may facilitate compliance with these recommendations. Improved medication safety requires a system-wide strategy standardized at least to the level of the institution; it is the responsibility of institutional leadership to introduce such strategies and of individual practitioners to engage in them.

FDA launches plan to prevent unnecessary harm from medication use

FDA in November announced the launch of the Safe Use Initiative, an undertaking intended to avert unnecessary adverse events arising from the inappropriate use of medications. “I feel strongly that reducing preventable harm from medication misuse should be a top priority for the FDA,” said Commissioner Margaret A. Hamburg during a November 4 media briefing. FDA is focusing on what Hamburg called “avoidable harm,” such as unintentional overdoses, dosing errors, and medication abuse. In a report announcing the initiative, FDA cited research indicating that at least 1.5 million avoidable adverse drug events occur in health care settings each year. Hamburg said that a majority of medication-related injuries “could be prevented using currently available knowledge.” The report set that figure at 11–50%. FDA officials acknowledged that a true measure of the extent of preventable medication harm in the United States does not exist, because data on the subject are not routinely collected. But FDA plans to work with the Centers for Disease Control and Prevention to develop population-based estimates of preventable harm from medications.