Analysis of Hospital Admissions Related to Adverse Drug Events Using ADE Signals

  • Lee Suk-Hyang (Graduate School of Clinical Pharmacy, Sookmyung Women's University) ;
  • Kim Hye-Young (Graduate School of Clinical Pharmacy, Sookmyung Women's University) ;
  • Lee Kyung-Hoon (Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Department of Molecular Cell Biology, School of Medicine, SungKyunKwan University) ;
  • Koo Hyun-Kyung (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Kim Yoon (Department of Health Policy and Management, Seoul National University College of Medicine)
  • Published : 2006.03.01

Abstract

Adverse drug events (ADEs) are the most common type of adverse events in medical practice. Hospital admissions related to ADEs cost high and should be monitored to prevent them. While concerns about the ADEs are increasing, the frequency and characteristics of admissions related to ADEs have not been reported in Korea. The objective of the study was to assess the rate of hospital admission related to ADEs and their characteristics through ADE signal-based retrospective reviews of medical records. As results, a total of 1,420 patients had ADE signals suggesting potential ADEs from 3,494 patients who discharged from an academic medical center over one month period. Six pharmacists independently assessed the presence of ADEs after the review of patients' medical records. Among the 3,494 discharges, 62 admissions (1.8%) were found to be realted to ADEs. Of admissions with ADEs, 83.9% were moderate (category F by the NCC MERP classification), 37.2% were preventable, and 85.5% were type A reaction. The most frequent suspected drugs causing ADEs were antineoplastics (48.9%), and the most frequent ADE signal detecting hospital admissions related to ADEs was white blood cell count (24.2%). Hospital admissions related to ADEs were found through screening the ADE signals. The ADE signal-based retrospective review could be a practical approach for identifying hospital admissions related to ADEs.

Keywords

References

  1. Bates DW, Leape LL, Petrycki S. (1993). Incidence and preventability of adverse drug events in hospitalized adults. J Gen Intern Med 8(6), 289-94 https://doi.org/10.1007/BF02600138
  2. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea.BF, Hallisey R, Vander VM, Nemeskal R, Leape LL. (1995). Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 274(1), 29-34 https://doi.org/10.1001/jama.274.1.29
  3. Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL. (1997). The costs of adverse drug events in hospitalized patients. JAMA 277(4), 307-11 https://doi.org/10.1001/jama.277.4.307
  4. Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander VM, Seger DL. (1998). Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 280(15),1311-6 https://doi.org/10.1001/jama.280.15.1311
  5. Bergman U, Wiholm BE. (1981). Drug-related problems causing admission to a medical clinic. Eur J Clin Pharmacol. 20(3) 193-200 https://doi.org/10.1007/BF00544597
  6. Bero LA, Lipton HL, Bird JA. (1991). Characterization of geriatric drug-related hospital readmissions. Med Care 29(10), 989-1003 https://doi.org/10.1097/00005650-199110000-00005
  7. Brennan TA, Localio AR, Leape LL, Laird NM, Peterson L, Hiatt HH, Barnes BA. (1990). Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals. Ann Intern Med. 112(3),221-6 https://doi.org/10.7326/0003-4819-112-3-221
  8. Caranasos GJ, Stewart RB, Cluff LE. (1974) Drug-induced illness leading to hospitalization. JAMA. 228(6),713-7 https://doi.org/10.1001/jama.228.6.713
  9. Choi S, Huh IH. (2001). Estimation of adverse drug reactions and methods to encourage the adverse drug monitoring in tertiary hospital. J of Kor Soc of Health-sys Pharm 18(1),64-77
  10. Choi YH, Sohn UD. (2003). The surveillance of adverse drug reaction reported. Kor J of Clin Pharm 13(2), 72-81
  11. Classen DC, Pestotnik SL, Evans RS, Burke JP. (1991). Computerized surveillance of adverse drug events in hospital patients. JAMA 266(20), 2847-51
  12. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. (1997). Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 277(4), 301-6 https://doi.org/10.1001/jama.277.4.301
  13. Col N, Fanale JE, Kronholm P. (1990). The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med Apr 150(4), 841-5 https://doi.org/10.1001/archinte.150.4.841
  14. Colt HG, Shapiro AP. (1989). Drug-induced illness as a cause for admission to a community hospital. J Am Geriatr Soc 37(4), 323-6 https://doi.org/10.1111/j.1532-5415.1989.tb05498.x
  15. Dartnell JG, Anderson RP, Chohan V, Galbraith KJ, Lyon ME, Nestor PJ, Moulds RF. (1996) Hospitalization for adverse events related to drug therapy: incidence, avoidability and costs. Med J Aust 164(11), 659-62
  16. deShazo RD, Kemp SF. (1997). Allergic Reactions to Drugs and Biologic Agents. JAMA 278 (22), 1897-1906
  17. Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme JF Jr, Lloyd JF, Burke JP. (1998). A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med. 338(4),232-8 https://doi.org/10.1056/NEJM199801223380406
  18. Evans RS, Pestotnik SL, Classen DC, Hom SD, Bass SB, Burke JP. (1994). Preventing adverse drug events in hospitalized patients. Ann Pharmacother 28(4), 523-7 https://doi.org/10.1177/106002809402800417
  19. Faich GA, Knapp D, Dreis M, Turner W. (1987). National adverse drug reaction surveillance JAMA 257(15), 2068-70 https://doi.org/10.1001/jama.257.15.2068
  20. Faich GA. (1986). Adverse-drug-reaction monitoring. N Engl J Med 314(24), 1589-92 https://doi.org/10.1056/NEJM198606123142427
  21. Faich GA. (1991). National adverse drug reaction reporting. 1984-1989. Arch Intern Med 151(8),1645-7 https://doi.org/10.1001/archinte.1991.00400080129025
  22. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW.: Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003 Mar 5;289(9): 1107-16 https://doi.org/10.1001/jama.289.9.1107
  23. Gurwitz TK, Burstin HR, Cook EF, Puopolo AL, Haas JS, Brennan TA, Bates DW. (2000) Drug complications in outpatients. J Gen Intern Med. Mar 15(3), 149-54 https://doi.org/10.1046/j.1525-1497.2000.04199.x
  24. Honigman B, Lee J, Rothschild J, Light P, Pulling RM, Yu T, Bates DW. (2001). Using computerized data to identify adverse drug events in outpatients. J Am Med Inform Assoc 8(3), 254-66 https://doi.org/10.1136/jamia.2001.0080254
  25. Ives TJ, Bentz EJ, Gwyther RE. (1987) Drug-related admissions to a family medicine inpatient service. Arch Intern Med 147 (6), 1117-20 https://doi.org/10.1001/archinte.147.6.1117
  26. Jha AK, Kuperman GJ, Rittenberg E, Teich JM, Bates DW. (2001) Identifying hospital admissions related to adverse drug events using a computer-based monitor. Pharmacoepidemiol Drug Saf 10(2), 113-9 https://doi.org/10.1002/pds.568
  27. Jha AK, Kuperman GJ, Teich JM, Leape L, Shea B, Rittenberg E, Burdick E, Seger DL, Vander Vliet M, Bates DW. (1998). Identifying adverse drug events: development of a computerbased monitor and comparison to chart review and stimulated voluntary report. J Am Med Inform Assoc 5(3),305-14 https://doi.org/10.1136/jamia.1998.0050305
  28. Keith MR, Bellanger-McCleery RA, Fuchs JE Jr. (1989). Multidisciplinary program for detecting and evaluating adverse drug reactions. Am J Hosp Pharm. 46(9), 1809-12
  29. Lakshmanan MC, Hershey CO, Breslau D. (1986) Hospital admissions caused by iatrogenic disease. Arch Intern Med 146 (10), 1931-4 https://doi.org/10.1001/archinte.146.10.1931
  30. Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics. 1977 Mar; 33(1): 159-74 https://doi.org/10.2307/2529310
  31. Lazarou J, Pomeranz BH, Corey PN. (1998). Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279(15), 1200-5 https://doi.org/10.1001/jama.279.15.1200
  32. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H. (1991). The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324(6), 377-84 https://doi.org/10.1056/NEJM199102073240605
  33. Levy M, Kewitz H, Altwein W, Hillebrand J, Eliakim M. (1980). Hospital admissions related to adverse drug reactions: a comparative study from Jerusalem and Berlin. Eur J Clin Pharmacol 17(1), 25-3 I https://doi.org/10.1007/BF00561673
  34. Levy M, Lipshitz M, Eliakim M. (1979). Hospital admission related to adverse drug reactions. Am J Med Sci 277(1),49-56 https://doi.org/10.1097/00000441-197901000-00006
  35. McKenney JM, Harrison WL. (1976). Drug-related hospital admissions. Am J Hosp Pharm 33(8), 792-5
  36. Melmon KL. (1971). Preventable drug reactions-causes and cures. N Engl J Med 284(24), 1361-8 https://doi.org/10.1056/NEJM197106172842408
  37. Miller RR. (1974). Hospital admissions related to adverse drug reactions. A report from the Boston Collaborative Drug Surveillance Program. Arch Intern Med 134(2), 219-23 https://doi.org/10.1001/archinte.134.2.219
  38. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. (1981). A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30(2), 239-45 https://doi.org/10.1038/clpt.1981.154
  39. Raschke RA, Gollihare B, Wunderlich TA, Guidry JR, Leibowitz AI, Peirce JC, Lemelson L, Heisler MA, Susong C. (1998). A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital. JAMA 280(15), 1317-20 https://doi.org/10.1001/jama.280.15.1317
  40. Schumock GT, Thornton JP. (1992). Focusing on the preventability of adverse drug reactions. Hosp Pharm. 27(6), 538
  41. Sills JM, Tanner LA, Milstien JB. (1986). Food and Drug Administration monitoring of adverse drug reactions. Am J Hosp Pharm. 43(11), 2764-70
  42. Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, Howard KM, Weiler PC, Brennan TA. (2000). Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 38(3),261-71 https://doi.org/10.1097/00005650-200003000-00003
  43. US Pharmcopea. The USP center for the advancement of patient safety. (2001) http://www.nccmerp.orgl. accessed on 07 May, 2004
  44. VHA (2002 ed): Monitoring adverse drug events: Finding the needles in the haystack
  45. WHO (1994). International Statistical Classification of Diseases and Related Health Problems, Tenth Revision
  46. Wu WK, Pantaleo N. (2003) Evaluation of outpatient adverse drug reactions leading to hospitalization. Am J Health-syst Pharm 60(3), 253-9