Identifying and characterizing preventable adverse drug events for prioritizing pharmacist intervention in hospitals

The approach and results for identifying and characterizing preventable adverse drug events (pADEs) that are key targets for pharmacist medication therapy management (MTM) are summarized.

This study was part of a larger effort aimed at developing an electronic health record-based prediction model (the complexity score, or C-score) that ranks hospitalized patients according to their risk for pADEs. An environmental scan of published epidemiologic pADE studies and national patient safety priority areas was conducted. The final list of candidate pADEs was then disseminated to ASHP members and a national technical expert panel (TEP) to evaluate the importance, prevalence, severity, preventability, and measurability of these pADEs. Polychoric correlation tests were performed to evaluate and quantify associations between importance and any of the constructs' mean rankings for each individual pADE.

The environmental scan yielded a total of 21 candidate pADEs, including drug-induced acute kidney injury, falls, respiratory depression, altered mental status, hemorrhage, hepatic failure, hypoglycemia, seizures, hypotension and bradycardia, ileus, blood dyscrasias, severe electrolyte imbalances, prolonged hyperglycemia, uncontrolled hypertension, uncontrolled arrhythmia, stress ulcers, hospital-acquired infections, uncontrolled hospital-acquired or community-acquired infection, uncontrolled pain, and venous thromboembolism. The survey confirmed all pADEs were important. Ranking of overall importance was mainly driven by perceived pADE severity and, to a lesser extent, by preventability and prevalence ratings.

A literature review and survey of ASHP and TEP members were used to compile a list of important hospital-acquired pADEs for incorporation into a model for prioritizing patients for MTM services.