Medication adverse events in the ambulatory setting: A mixed-methods analysis
Joanne Wong1, Shin-Yu Lee2,3, Urmimala Sarkar4,5
1University of California, San Francisco School of Pharmacy, San Francisco, CA, USA.
Summary
Adverse drug events in ambulatory care often involve anticoagulants, antibiotics, hypoglycemics, and opioids. Improving follow-up, prescribing practices, patient education, and drug interaction alerts can reduce harm.
Area of Science:
- Patient Safety
- Pharmacovigilance
- Health Informatics
Background:
- Ambulatory care settings present unique challenges for medication safety.
- Adverse drug events (ADEs) are a significant concern in outpatient healthcare.
- Understanding contributing factors to ADEs is crucial for developing targeted interventions.
Purpose of the Study:
- To analyze ambulatory care adverse drug events reported to the Collaborative Healthcare Patient Safety Organization (CHPSO).
- To identify the most frequently implicated medication classes in these events.
- To determine addressable contributing factors for medication-related harm in ambulatory care.
Main Methods:
- Analysis of deidentified ambulatory care reports from CHPSO (May 2012-October 2018).
- Focus on medication-related adverse events, identifying implicated drugs and contributing factors.
- Quantitative analysis of frequent item sets for contributing factors, followed by qualitative thematic analysis.
Main Results:
- Out of 1,244 events, 208 were medication-related.
- Top implicated drug classes: anticoagulants (46%), antibiotics (11%), hypoglycemics (9%), and opioids (8%).
- Common issues included lack of follow-up for anticoagulants, prescribing errors for antibiotics, poor education for hypoglycemics, and drug interactions with opioids.
Conclusions:
- Prescribing clinicians and pharmacists can mitigate harm from common drug classes.
- Recommendations include enhanced INR monitoring, improved antibiotic prescribing review, better patient education for hypoglycemics, and alerts for opioid co-prescriptions.
Keywords:
ambulatory caremedication errorsmedication therapy managementpatient safetypharmacovigilanceMore Related Videos
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