Drug-related emergency department visits and hospital admissions.

The incidence and causes of drug-related hospital admissions and visits to an emergency department were evaluated. A retrospective chart review was conducted to identify drug-related visits and admissions for all patients who visited the emergency department of a 517-bed tertiary-care institution during a four-month period. Drug-related illnesses were classified as adverse drug reaction (ADR), overdose or abuse, noncompliance, drug interaction, or toxicity. Patient data included demographic characteristics, medication history, serum drug concentrations, length of hospital stay, and hospital admission charges. Of 10,184 patients who visited the emergency department, 293 (2.9%) had drug-related illnesses; 71 (24%) of these patients were admitted. The drug classes most commonly involved were drugs of abuse (23.2%), anticonvulsants (17.1%), antibiotics (12.6%), respiratory drugs (8.9%), and pain medications (8.9%). The most common category of drug-related illness was overdose or abuse (35%) followed by noncompliance (28%), ADR (28%), toxicity (8%), and drug interaction (1%). The average length of stay for patients who were admitted was 5.8 days, and the average cost of admission was $8888. Drug-related illnesses accounted for 2.9% of hospital admissions and visits for patients in the emergency department. The most commonly identified drug-related illnesses were overdose or abuse, noncompliance, and ADRs; the drug classes most commonly implicated were drugs of abuse, anticonvulsants, and antibiotics.     

Drug-related visits to the medical emergency department: a prospective study from India

OBJECTIVE: To analyze the contribution of adverse drug events (ADEs) to the overall number of visits to the medical emergency and to determine the proportion of events leading to hospital admissions. PATIENTS AND METHODS: All visits to the medical emergency were recorded in a prospective, non-interventional design study over a period of 8 months. The ADEs were divided into 5 categories: adverse drug reactions (ADRs), drug interactions, patient non-compliance, physician non-compliance, and drug overdose. The cases were then followed-up to assess the prorportion of ADEs lead to hospitaliztion. RESULTS: A total of 4764 patients were included in the study. 5.9% of all visits were considered to be drug-related. The highest percentage of ADEs was observed in the age group less than 20 and more than 80 years. ADRs accounted for 45% of all ADEs, followed by patient non-compliance (28%). Patient and physician non-compliance were the main causes of drug-related hospital admissions. 52% of all ADE-related visits and 55% of ADE-related admissions were considered to be preventable. Non-steroidal antiinflammatory agents, oral hypoglycemics and antitubercular drugs were responsible for 37% of all ADRs. Non-compliance was mainly seen in hypertensives, asthmatics and epileptics. CONCLUSION: ADEs account for a sizable proportion of all visits to a medical emergency unit and some are serious enough to require hospitaliztion. A large number of ADE-related visits and admissions are preventable which highlights the importance of public education on the proper use of drugs, and also the need for regulation of the practice of unregistered medical practitioners in developing countries.     

Drug-related deaths in a university central hospital

OBJECTIVES: The objectives were to determine the incidence of drug-related deaths in a university hospital and to find out which drugs are most commonly involved in these cases. METHODS: The files of 1511 death cases (97.7% of all death cases in the Helsinki University Central Hospital during the year 2000) were scrutinised. In the cases of suspected drug-related deaths excluding suicides, the medication, its duration and indications, the route of drug administration, and the type of the adverse reactions were determined. The probability of a fatal adverse drug reaction was classified according to WHO's classification. In addition, the incidence of drug-related deaths was calculated from the death certificates. RESULTS: Scrutiny of the patients' files showed that 75 of the death cases (5.0% of all deaths) were certainly or probably drug-related. This corresponds to about 0.05% of all hospital admissions. The most common adverse reactions were neutropenia caused by antineoplastic agents and gastrointestinal or intracranial haemorrhage due to anticoagulants or nonsteroidal anti-inflammatory drugs (NSAIDs). The incidence of drug-related deaths is only 0.5% when based on the International Classification of Diseases (ICD) codes in death certificates. CONCLUSIONS: Adverse drug reaction is a significant cause of death. Most of the deaths occurred in seriously ill patients with high-risk medication and they are seldom preventable. Incidence figures based on death certificates only may seriously underestimate the true incidence of fatal adverse reactions.     

Developing a unit-of-use drug distribution system for the hospital emergency room

The development of a unit-of-use drug distribution system for hospital emergency rooms (ERs) is described. Initially, each emergency room physician was requested to compile a list of medications for an emergency room formulary. These lists were edited into a single list and presented to the ER Committee for review. This committee was to recommend the least number of medications possible per therapeutic category. During this time, the support of the ER staff was gained, policies and procedures were established, and a unit dose cart system was chosen. The final step was to present the recommended emergency room drug formulary to the Pharmacy and Therapeutics Committee for their review and approval. The advantages of this system are: establishment of pharmacy drug control in the ER; reduction of ER inventory; greatly improved drug security; proper drug labeling; and automatic restocking of medications in the ER, resulting in time savings for ER personnel.     

Drug-related hospital admissions in a generic pharmaceutical system

1. Generically based pharmaceutical systems exist in a few countries of the world, such as Iran. Most developed countries have free market pharmaceutical systems. Drug-related problems (DRP) have been reported mostly in the Western world but few data are available for generic systems. In this study, we tried to measure the prevalence of drug-related problems leading to hospital admissions in Isfahan, Iran. 2. One thousand consecutive hospital admissions in three major teaching hospitals were studied for a period of 6 months for the presence of DRP as a cause of hospital admissions. Two subcategories of DRP were considered: (i) drug therapy failure; and (ii) adverse drug reactions. Preventability and outcome measures were also assessed. Medications responsible for DRP were classified according to the Anatomic Therapeutic Chemical (ATC) classification of the World Health Organization. 3. Of the 1000 admissions studied, 115 (11.5%) were owing to DRP, 81% as a result of drug therapy failure and 19% as adverse drug reactions. A total of 106 out of the 115 DRP cases (92%) were either preventable or probably preventable, most of which had to do with either prescriber or patient error. An overview of DRP showed that 58.3% resulted in complete recovery, 33.9% in relative recovery and 7.8% in death. Close to 1% of hospital admissions resulted in DRP-related deaths. 4. The overall prevalence of hospital admissions caused by DRP is similar to that in free market pharmaceutical systems. The high preventability rate of these problems should alert clinicians and policy makers to design strategies to curtail this. Also, reasons for differences in subtypes of DRP between the results of this study and those of the literature from free market systems needs to be investigated further.     

Drug-related emergency department visits in older patients: an applicability and reliability study of an existing assessment tool

Background

AT-HARM10 is a research tool to identify possible drug-related hospital admissions. It is unclear whether the tool can be applied to emergency department visits as well.

Aim

The aim of this study was to investigate the applicability and reliability to identify drug-related emergency department visits in older patients with AT-HARM10.

Method

A random sample of 400 patients aged 65 years or older from a clinical trial in four Swedish hospitals was selected. All patients’ emergency department visits within 12 months after discharge were assessed with AT-HARM10. The main outcome measures were the percentage of successfully assessed visits for applicability and the interrater reliability (Cohen’s kappa).

Results

Of the initial sample (n = 400), 113 patients [median age (interquartile range): 81 (76–88) years] had at least one emergency department visit within 12 months. The patients had in total 184 visits, of which 179 (97%) were successfully assessed. Fifty-three visits (29%) were possibly drug-related. The Cohen’s kappa value was 0.70 (substantial).

Conclusion

It seems applicable and reliable to identify possible drug-related emergency department visits in addition to hospital admissions in older patients with AT-HARM10. As a consequence, the tool has been updated to support its novel use in clinical research.

     

Suspected adverse drug events requiring emergency department visits or hospital admissions

Objective: To analyse the contribution of adverse drug events (ADEs) to the overall number of referrals or visits at an emergency department, to determine the proportion of more severe episodes requiring hospital admission and to characterize the different causes of drug-related visits or admissions. Methods: A 1-year prospective collection of data on visits performed at an emergency department. All visits, observed during 1 week every month, were analyzed in order to identify suspected ADEs. The effects of age and sex on the frequency of ADE-related visits and admissions were evaluated. All patients hospitalized because of an ADE were followed up in order to collect information about progress and outcome of the events, which were also assessed in terms of avoidability. Results: Among the 5497 patients who visited the Emergency Department over 1 year, 235 (4.3%) experienced an ADE, 45 of these (19.1%) were subsequently hospitalized, among whom there were five deaths. Dose-related therapeutic failures were the main causes of drug-related admissions (55.6%), whereas adverse drug reactions caused the most frequent drug-related visits to the Emergency Department (63.8%). Although the frequency of drug-drug interactions leading to a visit to the Emergency Department was small (3.8%), this type of event was more severe, because most of these patients were hospitalized. No age/sex effect was observed in the proportion of ADE-related hospital admissions. Twenty-five (1.4% of the total admissions) of the 45 ADE-related admissions were evaluated as preventable, contributing by more than 61% of the overall length of hospital stay. Conclusion: The high proportion of drug therapeutic failures leading to an admission highlights the need for public education, particularly to prevent non-compliance. Received: 14 April 1998 / Accepted in revised form: 5 October 1998     

Resuscitation teaching room in a district general hospital: concept and practice.

Practical training in cardiopulmonary resuscitation presents a problem because of the shortage of teacher time and the many potential trainees. A resuscitation teaching room in district general hospital has been established, equipped with training mannikins and models, together with wall diagrams and cassette recordings. The arrangement enables many trainees to gain training in small groups with minimal demand on teachers. Experience with the room in use has suggested that the concept may have an application in many district general hospitals and possibly also in large industrial concerns.     

Air pollution and emergency room visits for cardiac arrhythmia in a subtropical city: Taipei,Taiwan

This study was undertaken to determine whether there was an association between air pollutant levels and emergency room (ER) visits for cardiac arrhythmia in Taipei, Taiwan. ER visits for cardiac arrhythmia and ambient air pollution data for Taipei were obtained for the period 2000–2006. The relative risk of ER visits was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant model, on warm days (≥23°C), statistically significant positive associations were found for all pollutants except SO₂. On cool days (<23°C), all pollutants were also significantly associated with the number of ER visits for cardiac arrhythmia, except SO₂. For the two-pollutant model, results for O₃ and NO₂ remained statistically significant on both warm and cool days. This study provides evidence that higher levels of ambient air pollutants increase the risk of ER visits for cardiac arrhythmia.     

Drug-related problems as a cause of hospital admissions in Hong Kong

The importance of drug-related problems as a cause of hospital admissions in Hong Kong was studied in 925 patients admitted to two general medical wards at the Prince of Wales Hospital between November 1992 and February 1993. Drug-related problems were judged to be the main reason for hospital admissions in 88 patients (9.5 per cent). These were adverse drug reactions (n = 57), drug poisoning (n = 22) and treatment failure consequent to noncompliance or inappropriate reduction in dosage (n = 9). The most important adverse drug reactions were gastrointestinal hemorrhage (36.8 per cent) and hypoglycemia (24.6 per cent), and the three drug classes that were most commonly involved were non-steroidal anti-inflammatory drugs (NSAIDs) (aspirin 12.3 per cent, non-aspirin 28.1 per cent), sulphonylureas (19.3 per cent) and diuretics (12.3 per cent). Drug-related problems are an important cause of hospital admissions, and much of the drug-induced illnesses in Hong Kong could be preventable if particular attention was given to NSAID and sulphonylurea therapy. Patients should also be educated about the importance of good drug compliance.     

Hospitalisations and emergency department visits due to drug-drug interactions: a literature review

PURPOSE: Our objective was to evaluate the incidence of adverse patient outcomes due to drug-drug interactions (D-DIs), the type of drugs involved and the underlying reason. As a proxy for adverse patient outcomes, emergency department (ED) visits, hospital admissions and re-hospitalisations were assessed. METHODS: A literature search in the Medline and Embase database (1990-2006) was performed and references were tracked. An overall cumulative incidence was estimated by dividing the sum of the cases by the sum of the study populations. RESULTS: Twenty-three studies were found assessing the relationship between D-DIs and ED-visits, hospitalisations or re-hospitalisations. The studies with a large study size showed low incidences and vice versa. D-DIs were held responsible for 0.054% of the ED-visits, 0.57% of the hospital admissions and 0.12% of the re-hospitalisations. In the elderly population, D-DIs were held responsible for 4.8% of the admissions. Drugs most often involved were NSAIDs and cardiovascular drugs. The reasons for admissions or ED-visits, which were most often found were GI-tract bleeding, hyper- or hypotension and cardiac rhythm disturbances. CONCLUSION: This review provides information on the overall incidence of D-DIs as a cause of adverse patient outcomes, although there is still uncertainty about the impact of D-DIs on adverse patient outcomes. Our results suggest that a limited number of drugs are involved in the majority of cases and that the number of reasons for admission as a consequence of D-DIs seems to be modest.     

Obstructed labor at a district hospital

A retrospective analysis of all deliveries that occurred at Jimma hospital, south western Ethiopia from September 1990 to May 1999 was conducted to determine the incidence, maternal and perinatal outcome, sociodemographic and clinical characteristics of mothers with obstructed labor. Seven percent (945/13,425) of the deliveries were complicated with obstructed labor with an overall increasing trend noted during the study period. Sixty seven percent of the cases were primigravida and grand multiparous mothers. Fourteen percent of obstructed labor occurred among teenage pregnant mothers. Forty four percent of the cases had no antenatal care while 35.1% had antenatal care. Cephalopelvic disproportion (CPD) was responsible for 80.6% of the cases, malpresentations accounting for the remainder, shoulder presentation being the commonest (11.5%). Fifty eight percent of the CPD cases were among the primigravida but para two to four mothers were not immune accounting for 25.7% of the cases, the rest being grand multipara, (15%). Fifty seven percent of the ruptured uterus cases were para two to four mothers while primigravids accounted for 7.2%. Maternal mortality was 9.1% while 62.1% of the perinates died with only 12.5% of the neonates having normal first minute apgar scores. Obstructed labor was the commonest cause of maternal and perinatal mortality at the hospital during the study period responsible for 45.5% and 37.4% of the deaths respectively. Any attempt to reduce maternal mortality at the hospital must comprehensively address the issue of obstructed labor, identify risk groups of mothers for this peripartum complication and design preventive strategies.     

Drug-related hospital admissions--an overview of frequency and clinical presentation

Adverse drug reactions (ADR) are the cause of hospital admissions for millions of patients every year and are believed to be a major problem in terms of morbidity and hospital expenses. ADR are characterized by exceptional variety, both considering pathomechanism and clinical symptoms. During the time period between 2000-2004 at the Department of Dermatology a project was undertaken to monitor patients who were hospitalized as a result of ADR. Within five years 57 patients, including 30 men and 27 women were observed. The majority of the patients developed maculaopapular rash (16), urticaria medicamentosa and Quincke's edema (16) and erythema multiforme (15). The other cases included erythroderma (5), anaphylactic shock (2), lichenoid exanthem (1), bullous eruption (1) and Hoigne's syndrome (1). The most probable factors producing these changes were concluded to be non-steroid antiinflammation drugs (33%), antibiotics (7%) and other drugs from different pharmacological and chemical groups (carbamazepine, diltiazem, hydrocortisone, methotrexate and herbs). The frequency of occurrence of skin changes of particular type in age groups were also analyzed. The greatest number of skin changes in response to drug therapy was in the age group 41 - 60, while for the age group > 60 ADR revealed the greatest diversity in the clinical picture. The most probable explanation of these findings are the polypragmasy applied in the elderly patients and interdrug interaction as well as decreased efficiency of the organic clearances.     

Drug-related problems in patients with ischemic stroke in hospital

Background Drug therapy is getting more complex, thus making it more challenging to prescribe appropriate drug therapy. Accordingly, in clinical practice, a wide range of drug-related problems (DRP) may arise; they are relatively common in hospitalised patients and can result in patient morbidity and mortality, and increased costs. Objective The objective was to investigate the nature and frequency of DRPs along with pharmaceutical interventions to address them in patients with ischemic stroke from hospital admission to discharge. Method From January to June 2011 patients with ischemic stroke, who were taking >2 drugs during hospital stay and at discharge, were recruited. A clinical pharmacist performed medication reconciliation on admission, and checked the medication records during the hospital stay regularly. DRPs were categorized by APS-Doc. Results In total, DRPs occurred in 105/155 (67.7?%) patients: Overall 271 DRPs were documented, with a mean of 1.8?±?2.0 DRPs per patient. The DRPs occurred mainly in the categories ??drug??, ??indication??, and ??dosage??. Conclusion In conclusion, DRPs are relatively common in hospitalised patients and may occur at any part of the prescribing process. The clinical pharmacist can provide a valuable contribution in the multidisciplinary team to an optimized pharmacotherapy in patients with ischemic stroke.     

Drug-related problems in a general paediatric ward of a tertiary care hospital in Malaysia

International Journal of Clinical Pharmacy - Background Drug-related problems are relatively common among hospitalised patients and may be detrimental to patients and even increase healthcare...