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Adverse drug events caused by medication errors in medical inpatients
Beat Hardmeier1, Suzanne Braunschweig, Marzia Cavallaro
1Division of Clinical Pharmacology and Toxicology, Department of Medicine, University Hospital, Zürich, Switzerland.
Principles:
In view of growing concern in recent years regarding medication errors as causes of adverse drug events (ADEs), we explore the frequency and characteristics of error-associated ADEs in medical inpatients.
Methods:
All patients with ADEs or ADErelated hospital admission in a cohort of medical inpatients identified by "event monitoring" (SAS/CHDM database, Br J Clin Pharmacol 2000:49:158-67) were evaluated independently by two experienced physicians. ADEs were first divided into ADEs occurring during cohort stay (incident ADE) and ADE present prior to/at admission. ADEs were then grouped as error-associated ADEs (eADEs: indication error, missed contraindication, wrong dosage regimen or inadequate surveillance) and adverse drug reactions (ADRs: indication established, no contraindications, appropriate dosage regimen and adequate surveillance).
Results:
Among the 6383 patients analysed (100%), 481 (7.5%) experienced at least one incident ADE. Incident ADRs occurred in 457 (7.2%). Incident eADEs were recorded in 28 patients, corresponding to an eADE incidence of 0.4% (95% CI: 0.2, 0.7). Error types were missing/inappropriate indication (4 cases), missed contraindications (9), relative overdoses (8), absolute overdoses (3) and inadequate clinical surveillance (4). The responsible drugs included antithrombotics (6), cardiovascular drugs (5), antibiotics (5), hypnotics (4) and non-steroidal anti-inflammatory drugs (3). ADE-related hospital admissions were observed in 262 patients (4.1%); 183 (2.9%) were classified as ADRs and 79 (1.2%) as eADEs.
Conclusions:
Incident eADEs were observed in 1 out of 250 patients and accounted for approximately 6% of ADEs. In contrast, eADEs accounted for 30% of ADE-related hospital admissions. Hence, in medical inpatients, eADEs represented a small fraction of total incident ADEs, whereas they contributed significantly to hospital admissions.
Insights
Medication errors causing adverse drug events (ADEs) are a concern. Error-associated ADEs (eADEs) were rare in medical inpatients but significantly contributed to hospital admissions.
Area of Science:
- Medical Inpatient Care
- Pharmacovigilance
- Patient Safety
Background:
- Growing concern over medication errors leading to adverse drug events (ADEs).
- Focus on the frequency and characteristics of error-associated ADEs in medical inpatients.
Purpose of the Study:
- To investigate the incidence and nature of error-associated ADEs in a cohort of medical inpatients.
- To differentiate between error-associated ADEs (eADEs) and adverse drug reactions (ADRs).
Main Methods:
- Analysis of medical inpatients with ADEs or ADE-related hospital admissions using "event monitoring".
- Independent physician evaluation to classify ADEs as incident ADEs or pre-existing.
- Categorization of ADEs into eADEs (e.g., wrong dosage) and ADRs (e.g., appropriate use).
Main Results:
- 7.5% of 6383 patients experienced incident ADEs; 0.4% were incident eADEs.
- Common error types included missed contraindications and overdoses.
- eADEs accounted for 1.2% of ADE-related hospital admissions, compared to 2.9% for ADRs.
Conclusions:
- Incident eADEs occurred in 1 in 250 patients, representing about 6% of all incident ADEs.
- eADEs constituted a significant proportion (30%) of ADE-related hospital admissions.
- While infrequent, eADEs have a substantial impact on hospital admissions in medical inpatients.
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