Adverse Drug Reactions Amongst Hospital & Emergency Patients Are Often Preventable

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Main Category: Public Health
Also Included In: Pharmacy / Pharmacist
Article Date: 07 Sep 2011 - 11:00 PDT


A presentation made Thursday 8th Sept. 2011 at The Annual Conference of International Pharmaceutical Federation (FIP) which is being held this year in Hyderabad, India concludes that adverse drug reactions (ADRs) amongst hospital and emergency patients are often preventable.

The researchers say that preventable ADRs being so common has important implications for healthcare.

Pharmacist Katja Hakkarainen, from the Nordic School of Public Health, Gothenburg, Sweden worked with colleagues to undertake the first meta-analysis of preventable adverse drug reactions (PADRs) in both outpatients and in-patients.

The researchers took 22 studies, measuring frequency of ADRs, as well as their preventability in hospital and emergency settings. (Meta-analysis combines several studies in order to present data that has more statistical depth.)

Their study finds that the frequency of PADRs leading to hospitalisation or emergency visits among adult outpatients was 2.0% and that 51% of all such ADRs were preventable. Among the elderly, preventability numbers climb as high as 71%. For in-patients, the frequency of PADRs was 1.6% and 45% of all such ADRs were preventable.

Ms Hakkarainen said:

"We knew that ADRs were common and that some of them were preventable. But no previous study had looked at their frequency in both in-patients and out-patients. We would have liked also to investigate their frequency in primary care, where the ADR did not lead to a hospital or emergency visit, but there are very few data available on this issue."

Preventable ADRs can be caused by a variety of circumstances, examples include:

• Treatment that maybe correct, but where the dose is too high for the patient.
• Poor monitoring of Internal bleeding associated with the use of anticoagulant (blood-thinning) therapy to prevent clotting, leading to potentially severe problems.
• Inappropriate use of painkillers that cause severe gastrointestinal bleeding.
• Other types of Preventable ADR may occur when there is a contraindication for a particular treatment, which is ignored or overlooked.

With more and more medications on the market and with them being used more frequently across all age groups, the occurrence of both ADRs and Preventable ADRs is bound to increase, so it is important to differentiate between the two.

Not all patients are created equally, and it is unfortunate that some ADRs do occur even through treatment is inline with recommendations. Others are relatively minor when the benefit of the treatment is taken into consideration. These kinds of ADRs cannot really be considered as preventable, and fall within a margin of error.

It is worth noting that some studies have shown that PADRs are often more severe than non-preventable ones. For example:

• One study shows 32% of all PADRs as severe, potentially life threatening, causing permanent damage, or requiring intensive care - while only 19% of the non-preventable ADRs were severe.
• In another, 65% of all PADRs caused a hospital admission or prolonged a hospital stay, while most non-preventable ADRs were less severe, with only 33% leading to hospital admission or a prolonged stay.

Whilst it may seem surprising that ADRs in hospital patients are somewhat high, researchers postulate the root cause as being poor information flow between heath units. It's not hard to envision long working hours combined with an incomplete medical history of a patient, especially in an emergency or life-threatening scenario leading to human error being made in good faith.

Ms Hakkarainen said:

"The reasons for high numbers of PADRs are varied; they may include poor co-ordination of care, lack of time and knowledge among health professionals, and lack of patient education. Unfortunately there is no consensus today on what to do to prevent ADRs. But our finding that they are so common means that it is imperative to create a climate in which they are not hidden and that there is no 'blame and shame' involved. Human error will occur while humans continue to work in healthcare and use medicines. Thus, safety measures need to be incorporated into the health system."

The study is a part of a larger project called 'Drug-Related Morbidity in Sweden (DRUMS) - prevalence, preventability and cost'. Three other studies are in progress which look at all types of drug-related morbidity, including ADRs, therapeutic failure and drug dependence.

Ms Hakkarainen said:

"In our original studies of ADRs, we were able to investigate them in greater depth and compare our results to other literature.

Although it is clearly important to carry out such studies, we would like to emphasise that for most of the time, medications do much more good than harm. We would not like to think of people discontinuing therapy as a result of our conclusions."

Written by Rupert Shepherd B.Sc.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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