Prevention of Adverse Drug Events

The pathway between a clinician s decision to prescribe a medication and the patient actually receiving the medication consists of several steps  

Ordering The clinician should select the appropriate medication and determine the dose and frequency of administration. 

Transcribing In a paper-based system, an intermediary (a clerk in the hospital setting, or a pharmacist or pharmacy technician in the outpatient setting) should read and interpret the 

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Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003 289(9) 1107-1116. 

Bates, D.W., Frequency, consequences and prevention of adverse drug events, J. Qual. Clin. Practice, 19 13-17 (1999). 

An important role for the pharmacist is prevention of adverse drug events (ADEs), which significantly contrib-... 

Bates DW, Leape LL, Petrycki S. Incidence and preventability of adverse drug events in hospitalized adults. J Gen Intern Med 1993 8 289-294. 

Gurwitz, J. H., and others. Incidence and Preventability of Adverse Drug Events in Nursing HomesP American Journal of Medicine, 2000, 109(2.), 87-94. 

Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995 274(1) 35 3. 

Medication errors occur primarily because of two reasons lack of knowledge or lapse in performance. In either case, if safety systems are not in place to prevent the error from going forward, an error can result. The more safety systems are in place, the greater the chance of the error being trapped before it gets to the patient. Leape and colleagues identified a number of proximal causes of medication errors in their study of causes of adverse drug events (Table 16.2). ... 

Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 1997 277 307-11. 

Prevention, diagnosis and treatment of adverse drug events are becoming more and more complex, and it is to be expected that physicians in all specialties and medical students are often perplexed by the nature of ADRs. To this end, I now offer a new, improved book that has evolved from the treasured drug eruption reference manual of previous editions. I hope that you will find this comprehensive new edition informative and valuable. 

Over the years the cost of human errors in the U.S. health care system has skyrocketed. The annual national cost of adverse events is about 38 billion, around 17 billion of which is associated with preventable adverse events [5]. Furthermore, the cost of adverse drug events alone in a U.S. hospital is approximately 5.6 million per year about 2.8 million of this amount is associated with preventable adverse drug events [6]. 

Bates, D. W, and others. Incidence of Adverse Drug Events and Potential Adverse Drug Events ADE Prevention Study GroupP Journal of the American Medical Association, 1995,... 

When drug therapy fails or if extensive coronary atherosclerosis is present, PCI is often performed to restore coronary blood flow, relieve symptoms, and prevent major adverse cardiac events. Patients with one or more critical coronary stenoses (i.e., greater than 70% occlusion of the coronary lumen) detected during coronary angiography may be candidates for PCI. Several catheter-based interventions maybe used during PCI, including ... 

The goal of therapy is to arrest physical and electroencephalo-graphic evidence of seizures, prevent recurrence of seizures, and minimize adverse drug events. 

Further goals include a return to usual activity and prevention of future injury. It is also important to minimize the potential for adverse drug events during treatment. 

Schnipper JL et al Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med 2006 166 565.[PMID 16534045]... 

Adverse drug events (ADEs), defined as any injury owing to a medication error, happen often. The Institute of Medicine has reported that at least 1.5 million preventable ADEs occur each year in hospitals and in people s homes. You can reduce your risk of having an ADE by having all your medications reviewed by your doctor or pharmacist. 

An excellent example of this is found in a study by Leape et al. (1995), which is referred to in greater detail in Chapter 12. The study found 264 preventable adverse drug events (ADEs) for which 16 major systems failures were identified as rmderlying causes of the errors. Of these 16 systems failures, 7 were responsible for 78% of the errors and were due to poor information systems. Thus, assigning blame to an individual or a certain procedure would have missed the cause entirely, which was likely the way that information was disseminated in the institution. Only by approaching the analysis from a systems perspective would it be possible to correct the real cause of the errors. 

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