A targeted method for standardized assessment of adverse drug events in surgical patients

Boer, M. de; Kiewiet, Jordy J. S.; Boeker, Eveline B.; Ramrattan, Maya A.; Dijkgraaf, Marcel G. W.; Lie‐A‐Huen, Loraine; Boermeester, Marja A.

doi:10.1111/jep.12033

Cited by 14 publications

(13 citation statements)

References 43 publications

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“…In the Surepill study, a trigger tool was used to pre‐select patients . Only patients with identified triggers in their charts were further assessed by an expert team for ADEs . For the purpose of this IPDMA, only ADEs that were identified by the trigger tool in the WINGS study were included, to optimize the comparability with the Surepill study.…”

Section: Discussionmentioning

confidence: 99%

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

Boeker

Ram

Klopotowska

et al. 2015

Brit J Clinical Pharma

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AIMThe incidence of adverse drug events (ADEs) in surgical and non-surgical patients may differ. This individual patient data meta-analysis (IPDMA) identifies patient characteristics and types of medication most associated with patients experiencing ADEs and suggests target areas for reducing harm and implementing focused interventions. METHODSAuthors of eligible studies on preventable ADEs (pADEs) were approached for collaboration. For assessment of differences among (non-)surgical patients and identification of associated factors descriptive statistics, Pearson chi-square, Poisson and logistic regression analyses were performed. For identification of high risk drugs (HRDs), a model was developed based on frequency, severity and preventability of medication related to ADEs. RESULTSIncluded were 5367 patients from four studies. Patients aged ≥ 77 years experienced more ADEs and pADEs compared with patients aged ≤ 52 years (odds ratios (OR) 2.12 (95% CI 1.70, 2.65) and 2.55 (95% CI 1.70, 3.84), respectively, both P < 0.05). Polypharmacy on admission also increased the risk of ADEs (OR 1.21 (95% CI 1.03, 1.44), P < 0.05) and pADEs (OR 1.85 (95% CI 1.34, 2.56), P < 0.05). pADEs were associated with more severe harm than non-preventable ADEs (54% vs. 32%, P < 0.05). The top five HRDs were antibiotics, sedatives, anticoagulants, diuretics and antihypertensives. Events associated with HRDs included diarrhoea or constipation, abnormal liver function test and central nervous system events. Most pADEs resulted from prescribing errors (90%). CONCLUSIONElderly patients with polypharmacy on admission and receiving antibiotics, sedatives, anticoagulants, diuretics or antihypertensives were more prone to experiencing ADEs. Efficiency in prevention of ADEs may be improved by targeted vigilance systems for alertness of physicians and pharmacists.

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Section: Discussionmentioning

confidence: 99%

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

Boeker

Ram

Klopotowska

et al. 2015

Brit J Clinical Pharma

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“…To study and describe the interaction and complementary value of the QIs and ADEs, each ADE and preventable ADE was linked to the corresponding QI domain, if possible. The method to detect and assess ADEs and preventable ADEs in this population is previously described by De Boer et al [13] …”

Section: Methodsmentioning

confidence: 99%

“…This approach seems effective [14] and widely accepted in several patient populations. [12], [13], [15]–[18] However, it is a time consuming method and depending on the substantial contribution of the expert panel.…”

Section: Introductionmentioning

confidence: 99%

Quality of Pharmaceutical Care in Surgical Patients

et al. 2014

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BackgroundSurgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements.ObjectiveTo assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements.MethodsFor this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients.ResultsThirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%).ConclusionsThis quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.

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“…To establish the prevalence of MEs and patient harm, we used a 3-step approach that was validated in a previous study. 17 During the first step, the clinical records of discharged patients were retrospectively reviewed by one of the investigators (J. M. or M. T.). Potential MEs were identified by reviewing all medication summaries, check-off lists, medical and nursing daily notes, symptom registration, and postoperative notes.…”

Section: Data Collectionmentioning

confidence: 99%

Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis

Maaskant

Tio

Hest

et al. 2018

Health Science Reports

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Objective: Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children. Method:We performed an interrupted time series analysis with 6 preintervention and 6 postintervention data collection points, in a tertiary pediatric intensive care unit. We included intensive care patients admitted during July to December 2013 (preintervention) and July to December 2014 (postintervention). The primary endpoint was the prevalence of MEs per 100 prescriptions. We reviewed the clinical records of the patients and the incident reporting system for MEs. If an ME was suspected, a pediatrician-intensivist and a clinical pharmacist determined causality and preventability. They classified MEs as harmful according to the National Coordinating Council for Medication Error Reporting and Prevention categories. Results:We included 254 patients in the preintervention period and 230 patients in the postintervention period. We identified 153 MEs in the preintervention period, corresponding with 2.27 per 100 prescriptions, and 90 MEs in the postintervention period, corresponding with 1.71 per 100 prescriptions. Autoregressive integrated moving average analyses revealed a significant change in slopes between the preintervention and postintervention periods (β = −.21; 95% CI, −0.41 to −0.02; P = .04). We did not observe a significant decrease immediately after the start of the intervention (β = −.61; 95% CI, −1.31 to 0.08; P = .07). Conclusion:The implementation of a structured medication audit, followed by feedback by a clinical pharmacist as part of the multidisciplinary team, resulted in a significant reduction of MEs in a tertiary pediatric intensive care unit. KEYWORDSharm, ITS, medication error, multifaceted intervention, pharmacist, PICU Because of the growing awareness of the complexity of the medication process and medication safety issues, it has been suggested that active involvement of a clinical pharmacist on pediatric wards might be of additional value. Three systematic reviews report a reduction of MEs after a pharmacist was employed on clinical wards, but the included studies do not provide a clear description of the interventions by the clinical pharmacist. [10][11][12] In addition, quality issues arise as most of the included publications involved observational studies, before-and-after designs were without a control group, or the MEs were self-reported by the intervening pharmacist. 10-12 A recentCochrane systematic review 13 included only 1 high-quality, controlled before-after study that showed a significant reduction of serious MEs after the implementation of a multifaceted intervention by a full-time clinical pharmacist on a PICU.14 Since available evidence is scarce, we decided to study the effect of a structure...

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A targeted method for standardized assessment of adverse drug events in surgical patients

Cited by 14 publications

References 43 publications

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

An individual patient data meta‐analysis on factors associated with adverse drug events in surgical and non‐surgical inpatients

Quality of Pharmaceutical Care in Surgical Patients

Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis

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