Hohl Corinne M, Woo Stephanie A, Cragg Amber, Wickham Maeve E, Ackerley Christine, Scheuermeyer Frank, Villanyi Diane
Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC.
CMAJ Open. 2019 Jul 18;7(3):E446-E453. doi: 10.9778/cmajo.20180190. Print 2019 Jul-Sep.
Adverse drug events are an important cause of preventable emergency department visits and hospital admissions. We examined repeat adverse drug events associated with outpatient medications resulting in acute care utilization.
This descriptive analysis combined data from 3 prospective multicentre observational studies, in which clinical pharmacists and physicians independently evaluated patients who visited the emergency department for adverse drug events in 3 hospitals in British Columbia. During these studies, an independent committee adjudicated all discordant and uncertain cases using a standardized algorithm. For the current study, we retrospectively reviewed the medical and research records of all patients 19 years of age and older who had been diagnosed with an adverse drug event during the primary studies to determine the proportion of repeat events. We used multivariable logistic regression to identify factors associated with repeat events; we adjusted for clustering at the hospital level for patient-level analyses and at the patient level for event-level analyses.
Among 12 977 patients, 1178 were diagnosed with 1296 adverse drug events at the point of care. Of these events, 32.5% (421 of 1296; 95% confidence interval [CI] 29.8%-35.1%) were repeat events, of which 75.3% (317 of 421; 95% CI 71.1%-79.5%) were deemed probably or definitely preventable as re-exposure to the culprit medication or repeat withdrawal of an indicated medication was inconsistent with best medical practice. Patients presenting with repeat events were more likely to have renal failure (odds ratio [OR] 2.01; 95% CI 1.32%-3.07%) or a mental health diagnosis (OR 1.39; 95% CI 1.02%-1.88%).
A high proportion of adverse drug events were repeat events, most of which were deemed preventable. Interventions to ensure that care providers are aware of previously diagnosed adverse drug events when prescribing or dispensing need to be developed and evaluated and may reduce unintentional re-exposures to previously harmful medications.
药物不良事件是导致可预防的急诊科就诊和住院的重要原因。我们研究了与门诊药物相关的重复药物不良事件，这些事件导致了急性医疗服务的使用。
这项描述性分析合并了来自3项前瞻性多中心观察性研究的数据，在这些研究中，临床药剂师和医生独立评估了不列颠哥伦比亚省3家医院因药物不良事件前往急诊科就诊的患者。在这些研究期间，一个独立委员会使用标准化算法对所有不一致和不确定的病例进行裁决。对于当前的研究，我们回顾性审查了所有19岁及以上在初步研究中被诊断为药物不良事件的患者的医疗和研究记录，以确定重复事件的比例。我们使用多变量逻辑回归来识别与重复事件相关的因素；在患者层面分析时，我们对医院层面的聚类进行了调整，在事件层面分析时，我们对患者层面进行了调整。
在12977名患者中，有1178名在医疗现场被诊断出1296起药物不良事件。在这些事件中，32.5%（1296起中的421起；95%置信区间[CI]29.8%-35.1%）为重复事件，其中75.3%（421起中的317起；95%CI 71.1%-79.5%）被认为可能或肯定是可预防的，因为再次接触罪魁祸首药物或再次停用已指明的药物与最佳医疗实践不一致。出现重复事件的患者更有可能患有肾衰竭（比值比[OR]2.01；95%CI 1.32%-3.07%）或有精神健康诊断（OR 1.39；95%CI 1.02%-1.88%）。
很大一部分药物不良事件是重复事件，其中大多数被认为是可预防的。需要制定和评估干预措施，以确保医护人员在开处方或配药时了解先前诊断的药物不良事件，这可能会减少无意中再次接触先前有害药物的情况。
