Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools

被引:22
作者
Wright, Adam [1 ,2 ,3 ]
Feblowitz, Joshua [3 ]
Phansalkar, Shobha [3 ]
Liu, Jialin [4 ]
Wilcox, Allison [3 ]
Keohane, Carol A. [1 ]
Seger, Diane L.
Bloomrosen, Meryl [5 ]
Kuperman, Gilad J. [6 ,7 ]
Bates, David W. [2 ,3 ,8 ]
机构
[1] Brigham & Womens Hosp, Ctr Excellence Patient Safety Res & Practice, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] PH, Boston, MA USA
[4] Sichuan Univ, W China Hosp, Ctr Med Informat, Chengdu, Sichuan Provinc, Peoples R China
[5] Amer Med Informat Assoc, Bethesda, MD USA
[6] New York Presbyterian Hosp, New York, NY USA
[7] Weill Cornell Med Coll, New York, NY USA
[8] Brigham & Womens Hosp, Div Gen Med & Primary Care, Boston, MA 02115 USA
基金
美国医疗保健研究与质量局;
关键词
Computers; Drug interactions; Drugs; adverse reactions; Errors; medication; Hospitals; Medication orders; PHYSICIAN ORDER ENTRY; MEDICATION ERRORS; HOSPITALIZED-PATIENTS; COSTS;
D O I
10.2146/ajhp110084
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose. The results of a retrospective evaluation of the frequency and preventability of adverse drug events (ADEs) involving multiple drugs among hospital inpatients are reported. Methods. Data collected in a previous cohort study of 180 actual ADEs and 552 potential ADEs (PADEs) at six community hospitals in Massachusetts were analyzed to determine the frequency and types of multiple-drug ADEs and the extent to which the ADEs might have been prevented using publicly available clinical decision-support (CDS) knowledge bases. None of the hospitals had a computerized prescriber-order-entry system at the time of data collection (January 2005-August 2006). Results. A total of 17 ADEs (rate, 1.4 per 100 admissions) and 146 PADEs (rate, 12.2 per 100 admissions) involving multiple drugs were identified. The documented events were related to drug duplication (n = 126), drug-drug interaction (n = 21), additive effects (n = 14), and therapeutic duplication (n = 7) or a combination of those factors. The majority of actual ADEs were due to drug-drug interactions, most commonly involving opioids, benzodiazepines, or cardiac medications; about 75% of the PADEs involved excessive drug doses resulting from order duplication or the prescribing of combination drugs with overlapping ingredients, usually products containing acetaminophen and an opioid. It was determined that 5 (29.4%) of the ADEs and 131 (89.7%) of the PADEs could have been detected through the use of the evaluated CDS tools. Conclusion. A substantial number of actual ADEs and PADEs in the community hospital setting may be preventable through the use of publicly available CDS knowledge bases.
引用
收藏
页码:221 / 227
页数:7
相关论文
共 26 条
  • [1] Effect of computerized physician order entry and a team intervention on prevention of serious medication errors
    Bates, DW
    Leape, LL
    Cullen, DJ
    Laird, N
    Petersen, LA
    Teich, JM
    Burdick, E
    Hickey, M
    Kleefield, S
    Shea, B
    Vander Vliet, M
    Seger, DL
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (15): : 1311 - 1316
  • [2] RELATIONSHIP BETWEEN MEDICATION ERRORS AND ADVERSE DRUG EVENTS
    BATES, DW
    BOYLE, DL
    VLIET, MVV
    SCHNEIDER, J
    LEAPE, L
    [J]. JOURNAL OF GENERAL INTERNAL MEDICINE, 1995, 10 (04) : 199 - 205
  • [3] INCIDENCE OF ADVERSE DRUG EVENTS AND POTENTIAL ADVERSE DRUG EVENTS - IMPLICATIONS FOR PREVENTION
    BATES, DW
    CULLEN, DJ
    LAIRD, N
    PETERSEN, LA
    SMALL, SD
    SERVI, D
    LAFFEL, G
    SWEITZER, BJ
    SHEA, BF
    HALLISEY, R
    VANDERVLIET, M
    NEMESKAL, R
    LEAPE, LL
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (01): : 29 - 34
  • [4] The costs of adverse drug events in hospitalized patients
    Bates, DW
    Spell, N
    Cullen, DJ
    Burdick, E
    Laird, N
    Petersen, LA
    Small, SD
    Sweitzer, BJ
    Leape, LL
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 277 (04): : 307 - 311
  • [5] The impact of computerized physician order entry on medication error prevention
    Bates, DW
    Teich, JM
    Lee, J
    Seger, D
    Kuperman, GJ
    Ma'Luf, N
    Boyle, D
    Leape, L
    [J]. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 1999, 6 (04) : 313 - 321
  • [6] Berga Cullere C, 2009, Farm Hosp, V33, P312
  • [7] Brown SH, 2004, STUD HEALTH TECHNOL, V107, P477
  • [8] Adverse drug events in hospitals: a systematic review
    Cano, Fabiola Giordani
    Rozenfeld, Suely
    [J]. CADERNOS DE SAUDE PUBLICA, 2009, 25 : S360 - S372
  • [9] Adverse drug events in hospitalized patients - Excess length of stay, extra costs, and attributable mortality
    Classen, DC
    Pestotnik, SL
    Evans, RS
    Lloyd, JF
    Burke, JP
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 277 (04): : 301 - 306
  • [10] Food and Drug Administration, FREQ ASK QUEST COMB