Adverse Drug Events in Older Hospitalized Patients: Results and Reliability of a Comprehensive and Structured Identification Strategy

Abstract

BackgroundOlder patients are at high risk for experiencing Adverse Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in these vulnerable patients, hospitals first need to measure the occurrence of ADEs, especially those that are preventable. However, data on preventable ADEs (pADEs) occurring during hospitalization in older patients are scarce, and no ‘gold standard’ for the identification of ADEs exists.MethodologyThe study was conducted in three hospitals in the Netherlands in 2007. ADEs were retrospectively identified by a team of experts using a comprehensive and structured patient chart review (PCR) combined with a trigger-tool as an aid. This ADE identification strategy was applied to a cohort of 250 older hospitalized patients. To estimate the intra- and inter-rater reliabilities, Cohen’s kappa values were calculated.Principal FindingsIn total, 118 ADEs were detected which occurred in 62 patients. This ADE yield was 1.1 to 2.7 times higher in comparison to other ADE studies in older hospitalized patients. Of the 118 ADEs, 83 (70.3%) were pADEs; 51 pADEs (43.2% of all ADEs identified) caused serious patient harm. Patient harm caused by ADEs resulted in various events. The overall intra-rater agreement of the developed strategy was substantial (κ = 0.74); the overall inter-rater agreement was only fair (κ = 0.24).Conclusions/SignificanceThe ADE identification strategy provided a detailed insight into the scope of ADEs occurring in older hospitalized patients, and showed that the majority of (serious) ADEs can be prevented. Several strategy related aspects, as well as setting/study specific aspects, may have contributed to the results gained. These aspects should be considered whenever ADE measurements need to be conducted. The results regarding pADEs can be used to design tailored interventions to effectively reduce harm caused by medication errors. Improvement of the inter-rater reliability of a PCR remains challenging.

Reliability of the spine adverse events severity system (SAVES) for individuals with traumatic spinal cord injury

“…The results from the latter study may differ from ours as Klopotowska et al, 14 had a senior physicianpharmacist team as reviewers whereas our study involved reviewers from various disciplines. 14 Also, Klopotowska et al, 14 limited their patient population to those over the age of 65 who were receiving more than five medications, and restricted the type of AEs collected to those that arose from medications whereas our study used no such limits. 14 Individuals using the SAVES-SCI should be trained on how to grade AEs, particularly for the pre-and post-surgical intervention AEs with low kappa values.…”

“…The literature reports mixed results in this area. Sharek et al, 15 reported higher kappa for identifying than grading AEs, whereas Klopotowska et al, 14 reported higher agreement for grading than identifying AEs for both intra-rater and inter-rater reliability. The results from the latter study may differ from ours as Klopotowska et al, 14 had a senior physicianpharmacist team as reviewers whereas our study involved reviewers from various disciplines.…”

“…Sharek et al, 15 reported higher kappa for identifying than grading AEs, whereas Klopotowska et al, 14 reported higher agreement for grading than identifying AEs for both intra-rater and inter-rater reliability. The results from the latter study may differ from ours as Klopotowska et al, 14 had a senior physicianpharmacist team as reviewers whereas our study involved reviewers from various disciplines. 14 Also, Klopotowska et al, 14 limited their patient population to those over the age of 65 who were receiving more than five medications, and restricted the type of AEs collected to those that arose from medications whereas our study used no such limits.…”

Polypharmacy and Oral Health among the Elderly

“…Previous studies show that number of prescribed medicines increases with aging [10]. Polypharmacy causes an increase in the risk of side effects and interaction between medicines, treatment costs, hospitalization requirements, rates of incompatibility to medical treatment and resulting problems [11].…”

Advanced practice in paediatric pharmacy: What is it, how do you get there, and what does it mean for children?

“…20 In this study we also explicitly included temporary harm, emotional or psychological harm, pain requiring intervention and abnormal laboratory values, as used in other recent research. 21,22 Adverse Medication (Drug) Event…”