Occurrence Of Adverse Drug Events Research Articles

Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions.A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high.Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be beneficial to improve the reliability of results. Preliminary evidence suggests that programmes aimed at comprehensively assessing geriatric conditions, detecting 'high-risk' prescriptions and training patients to comply with prescribed therapies could be costeffective measures to reduce the burden of ADEs.

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INTRODUCTION At all interfaces of care during a hospital stay (admission, transfer, and discharge), the potential exists for inaccurate information about a patient’s drug therapy to be used for various purposes. If inaccurate information is used in establishing or modifying therapy, adverse drug events may occur. Such adverse events may span the range of drug-related problems, from inappropriate initiation or discontinuation to inappropriate route or dose. Medication reconciliation upon admission to hospital has been recognized as an important process in preventing adverse drug events at one interface of care.1 Conceptually, medication reconciliation on admission involves compiling an accurate list of the patient’s medications before admission (the best possible medication history [BPMH]) and ensuring that any subsequent therapy does not result in new drug-related problems. For optimal therapeutic transition, the BPMH would be obtained before any admission orders were written. However, many factors, such as cognitive impairment or a need to stabilize the patient’s condition, can prevent completion of the BPMH before in-hospital initiation of therapy. An alternative approach would be to compare the BPMH with therapy prescribed in hospital at some point after admission. This would allow prompt and efficient initiation of drug therapy but would also ensure subsequent review to identify and resolve any discrepancies. Such a comparison between the BPMH and admission orders ensures continuation of all appropriate medications while the patient is in hospital. Because medication reconciliation will be a requirement for hospital accreditation by 2010,1 it was necessary to devise a strategy for implementing this process at the authors’ hospital. Until now, physicians and nurses have reviewed each patient’s history at the time of admission, although neither discipline has medication use as the primary focus of these investigations. Pharmacists have extensive knowledge about medications, as well as the patient-interviewing skills required for high-quality assessment of patients’ drug therapy needs during transitions of care. However, pharmacists’ expertise would be better used in assessing the appropriateness of therapy rather than performing the technical task of compiling a BPMH. Because of resource constraints leading to inadequate attention or time on the part of physicians, nurses, and pharmacists, an alternative method of obtaining the BPMH was required. Although some institutions have assisted the admitting physicians or nurses by developing a standardized documentation form for use during the admission process, such forms have not been demonstrated to improve the rate of identified discrepancies upon admission.2 The use of pharmacy students for medication reconciliation has been reported, but the need to ensure a continuous supply of students and to provide training for new students limits the applicability of this method for most institutions.3 Several centres have studied the participation of pharmacy technicians in the medication reconciliation process.4-7 In these studies and others, the technicians were able to complete the BPMH with a 95% accuracy rate (B. Tugwood, Trillium Health Centre, personal communication by e-mail, January 29, 2008), and their involvement in medication reconciliation reduced the time spent by physicians, nurses, and pharmacists at the time of admission (L. Saulnier, South-East Regional Health Authority, personal communication by e-mail, August 14, 2007). When working in conjunction with a pharmacist, technicians can obtain the information necessary for timely identification and reconciliation of discrepancies, thus helping to prevent the occurrence of adverse drug events. Pharmacy technicians appear to be suitable candidates for completing medication histories. They are familiar with the dosage forms, strengths, and usual dosing schedules of a wide range of medications. In addition, they have received training about the medications that can be obtained without a prescription, which facilitates the identification of medications not included in prescription databases, such as the BC PharmaNet. Although lacking a pharmacist’s understanding of the indications, side effects, and combinations of medications, pharmacy technicians have many skills that allow identification of medications used on an outpatient basis. The study reported here was undertaken to demonstrate the feasibility of training a hospital pharmacy technician to obtain the BPMH and to communicate discrepancies to the pharmacist for patients who had been admitted to a tertiary care hospital.

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Occurrence Of Adverse Drug Events Research Articles

Articles published on Occurrence Of Adverse Drug Events

Impact of vendor computerized physician order entry on patients with renal impairment in community hospitals

Increased risk of hip fracture among older people using antidepressants subtitle: A nationwide cohort study in Norway

Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy.

Adverse drug events in surgical patients: an observational multicentre study

Safety monitoring of artemisinin combination therapy through a national pharmacovigilance system in an endemic malaria setting

Adverse drug events in a paediatric intensive care unit: a prospective cohort

Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment: improving drug safety in primary healthcare by low eGFR alerts

Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?

The Economic Burden of Inappropriate Drug Prescribing, Lack of Adherence and Compliance, Adverse Drug Events in Older People

A profile of adverse drug reactions with risk factors among geriatric patients in a tertiary care teaching rural hospital in India

Adverse drug events in an intensive care unit of a university hospital

Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code-assisted medication administration system

Misuse of over-the-counter medications among community-dwelling older adults and associated adverse drug events

Adaptação dos critérios de avaliação de eventos adversos a medicamentos para uso em um hospital público no Estado do Rio de Janeiro

Electronic health records and adverse drug events after patient transfer

Evaluation of intramuscular fosphenytoin vs intravenous phenytoin loading in the ED

Tailoring adverse drug event surveillance to the paediatric inpatient

Adverse Drug Events in Adult Patients Leading to Emergency Department Visits

Best Possible Medication History by a Pharmacy Technician at a Tertiary Care Hospital

Identifying Missed Opportunities to Curtail Antimicrobial Therapy for Presumed Ventilator-Associated Pneumonia Using the Clinical Pulmonary Infection Score

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Occurrence Of Adverse Drug Events Research Articles

Articles published on Occurrence Of Adverse Drug Events

Impact of vendor computerized physician order entry on patients with renal impairment in community hospitals

Increased risk of hip fracture among older people using antidepressants subtitle: A nationwide cohort study in Norway

Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy.

Adverse drug events in surgical patients: an observational multicentre study

Safety monitoring of artemisinin combination therapy through a national pharmacovigilance system in an endemic malaria setting

Adverse drug events in a paediatric intensive care unit: a prospective cohort

Optimising drug prescribing and dispensing in subjects at risk for drug errors due to renal impairment: improving drug safety in primary healthcare by low eGFR alerts

Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?

The Economic Burden of Inappropriate Drug Prescribing, Lack of Adherence and Compliance, Adverse Drug Events in Older People

A profile of adverse drug reactions with risk factors among geriatric patients in a tertiary care teaching rural hospital in India

Adverse drug events in an intensive care unit of a university hospital

Risk of adverse drug events in neonates treated with opioids and the effect of a bar-code-assisted medication administration system

Misuse of over-the-counter medications among community-dwelling older adults and associated adverse drug events

Adaptação dos critérios de avaliação de eventos adversos a medicamentos para uso em um hospital público no Estado do Rio de Janeiro

Electronic health records and adverse drug events after patient transfer

Evaluation of intramuscular fosphenytoin vs intravenous phenytoin loading in the ED

Tailoring adverse drug event surveillance to the paediatric inpatient

Adverse Drug Events in Adult Patients Leading to Emergency Department Visits

Best Possible Medication History by a Pharmacy Technician at a Tertiary Care Hospital

Identifying Missed Opportunities to Curtail Antimicrobial Therapy for Presumed Ventilator-Associated Pneumonia Using the Clinical Pulmonary Infection Score