J Clin Outcomes Manage
Adverse drugs events leading to admission at a community nonteaching hospital
Edwards DB, Heisler M, Guidry J, Jordan RM
Abstract Objective: To determine the rate of adverse drug events (ADEs) leading to admission in a community hospital. Design: Observational study. Setting: Community nonteaching hospital in Arizona. Methods: We assessed adult patients aged over 17 years admitted to the medical, general surgery, or intensive care unit services. Clinical pharmacists evaluated potential ADEs using both information technology (IT)–based and non–IT-based methods. Each admission identified in the screening process was evaluated in depth by a clinical pharmacist via chart audit and discussion with the patient, caregivers, and clinicians as appropriate. Causality was assessed by the clinical pharmacist and classified as definite (confirmed by drug level or other objective evidence), probable (more likely than not), or contributory (a major contributing factor in the admission). Results: 2.4% of the admissions were related to ADEs. 3.2% of these admissions were associated with fatality. ADEs associated with anticoagulants (30%) and cardiovascular medications (28%) were most commonly seen. 51% of patients who were on warfarin for atrial fibrillation and admitted for a bleeding complication had a contraindication to its use. Among patients with multiple admissions secondary to ADEs, digoxin and warfarin were overrepresented. Conclusion: ADEs are a common contributing cause of admission to a community hospital. Medications leading to admission differ when compared with academic or teaching facilities.
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