Descriptive study of drug-drug interactions attributed to prescriptions written upon discharge from the emergency department

Jawaro, Tara; Bridgeman, Patrick; Mele, Jude; Wei, Grant

doi:10.1016/j.ajem.2019.01.049

Cited by 7 publications

(8 citation statements)

References 15 publications

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“…The proportion of patients in the ED with at least one DDI in their medication was reported in other studies to be 39 % and 48 %, respectively, but did not refer exclusively to elderly patients. 8,35 In our study, 43.3 % of all patients had at least one DDI in their medication list before psychiatric consultation and 50 % thereafter. The mean number of DDIs per patient was 1.2 before and 1.3 after psychiatric consultation, a non-significant difference.…”

Section: Discussionmentioning

confidence: 58%

“…This appears comparable to the aforementioned studies and does not suggest any specific risks arising from the pharmacological recommendations made by the consultation service. 8,35 In summary, the proportion of newly recommended drugs listed as PIMs differed substantially depending on the applied PIM classification system. The FORTA classification declared the proportion of PIMs markedly higher than the PRISCUS list, which was due in particular to the contrasting categorization of two commonly prescribed drugs, that is, pipamperone and risperidone.…”

Section: Discussionmentioning

confidence: 99%

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Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department—A Retrospective Cohort Study

Westhoff

Schröder

Heck

et al. 2023

J Geriatr Psychiatry Neurol

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Objective Geriatric patients account for a significant proportion of the collective treated by psychiatric consultation service in hospitals. In the Emergency Department (ED), psychotropic drugs are frequently recommended, notwithstanding their extensive side-effect profiles. This study sought to investigate medication safety of geriatric patients referred to psychiatric consultation service in the ED. Methods Medication lists of 60 patients from the general internal medicine and trauma surgery EDs referred to psychiatric consultation service were analyzed. Utilizing PRISCUS list and Fit fOR The Aged (FORTA) classification, prescriptions of potentially inappropriate medications (PIMs) were assessed. Results 84 drugs were newly prescribed following psychiatric consultations. The total number of drugs per patient was 5.4 ± 4.2 before psychiatric consultation and 6.5 ± 4.2 thereafter ( p < .001). 22.6 % of the newly recommended drugs were PIMs according to the PRISCUS list, while 54.8 % were designated as therapeutic alternatives to PIMs. 54.8 % and 20.2 % of the newly recommended drugs were FORTA category C and D drugs, respectively. An average of 1.2 ± 1.7 drug–drug interactions (DDIs) existed before psychiatric consultation and 1.3 ± 1.9 DDIs thereafter ( p = .08). Conclusion The majority of newly recommended drugs by psychiatric consultation service in the ED were designated as suitable therapeutic alternatives to PIMs according to the PRISCUS list, but had comparatively unfavorable ratings according to the FORTA classification, demonstrating discrepancies between these two PIM classification systems. Physicians delivering psychiatric consultation services in the ED should not solely rely on one PIM classification system.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department—A Retrospective Cohort Study

Westhoff

Schröder

Heck

et al. 2023

J Geriatr Psychiatry Neurol

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Section: Discussionmentioning

confidence: 99%

“…A recent US study showed that among patients discharged from the emergency department, 1.6% presented with at least one contraindicated potential DDI and the majority of these DDIs involved QT prolongation. 20 Furthermore, LQTS is one of the most common reasons for drug withdrawal from the market. 21 It is a well‐known potential adverse event with anti‐arrhythmic drugs but also with other non‐cardiac drugs, such as antipsychotics and anti‐allergic drugs (list available on https://www.crediblemeds.org/ ).…”

Section: Discussionmentioning

confidence: 99%

Emergency department admissions induced by drug–drug interactions in the elderly: A cross‐sectional study

Létinier

Pujade

Duthoit

et al. 2022

Clinical Translational Sci

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The elderly people are increasingly exposed to polymedication and therefore to the risks of drug–drug interactions (DDIs). However, there are few data available on the clinical consequences of these drug combinations. We investigated the impact of the various DDIs classified as severe in terms of emergency admissions in the elderly. A cross‐sectional study was conducted using information from the emergency department admissions of Bordeaux University Hospital between September 2016 and August 2017. Events of interest were frequency of concomitant uses of interacting drugs that are contraindicated or warned against and frequency of emergency admissions due to contraindicated or warned against concomitant uses of interacting drugs. Five thousand, eight hundred sixty (5860) admissions to the emergency department were analyzed. A total of 375 (6.4%) contraindicated or warned against concomitant uses were identified, including 163 contraindicated (43.5%) and 212 warned against (56.5%). Reason for admission appeared likely related to the underlying DDI in 58 cases. Within these, 36 admissions were assessed as probably due to a DDI (0.6% of hospitalizations) and 22 as certainly (0.4% of hospitalizations). Of these, there were 24 (45%) admissions related to a long QT syndrome (LQTS), nine (16%) related to a drug overdose, and eight (14%) related to a hemorrhage. An antidepressant was involved in 22 of the 24 cases of LQTS. Seven of the eight cases of hemorrhage involved the antithrombotic agents / non‐steroidal anti‐inflammatory drugs combination. Elderly patients admitted to emergency departments are particularly exposed to high‐risk potential DDIs. These drug combinations lead mainly to LQTS and involve certain antidepressants.

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“…[ 6 ] A recent observational study found up to 38% of prescriptions written upon discharge from the Emergency Department (ED) have at least one DDI. [ 7 ] Several previous studies also reported high DDI in patients with polypharmacy. [ 1 , 8 – 13 ] Polypharmacy is common in elderly patients due to treating previously multiple medical conditions.…”

Section: Introductionmentioning

confidence: 97%

Factors associated with a basic common drug-drug interaction knowledge among emergency department medical personnel

Tangsuwanaruk

Wittayachamnankul²

2022

BMC Pharmacol Toxicol

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Background Drug-drug interactions (DDIs) are common but less concerning in clinical practice of time-sensitive situations. We aimed to identify factors associated with a basic common DDI knowledge among an emergency physician (EP), an emergency medicine resident (EMR), and an emergency care nurse (ECN). Methods This was a prospective cross-sectional study. EP, EMR, and ECN did the examination (multiple-choice questions, 40 points) about common DDI. Prespecified factors associated with examination scores were profession, longer emergency medicine experience, pharmacological training, last advanced cardiovascular life support (ACLS) training, DDI checker book, and application user experience. The outcome was an examination score to evaluate the ability of DDI knowledge. Univariable and multivariable means regressions were used. Results A total of 244 participants were enrolled. Factors associated with high examination score were EP (unadjusted mean difference 3.3 points, 95% confidence interval [CI] 2.1 to 4.5, p < 0.001), EMR (2.1, 95% CI 0.7 to 3.5, p 0.005) compared to ECN. Last ACLS training within 2 years (3.7, 95% CI 0.7 to 6.6, p 0.015), 2–4 years (3.4, 95% CI 0.4 to 6.5, p 0.027), and ≥4 years (4.4, 95% CI 1.2 to 7.6, p 0.007) were higher score than no ACLS training. Moreover, the DDI checker application experience user (1.7, 95% CI 0.6 to 2.8, p 0.003) also had a high score compared to the non-experienced user. After adjustment for all factors, EP (adjusted mean difference 3.3 points, 95% CI 1.8 to 4.7, p < 0.001), EMR (2.5, 95% CI 0.6 to 4.3, p 0.010) were higher scores compared to ECN. Meanwhile, the last ACLS training ≥4 years (3.3, 95% CI 0.1 to 6.6, p 0.042) was a higher score than no ACLS training. Conclusion EP, EMR, and the last ACLS training ≥4 years were associated with higher DDI knowledge than ECN and no ACLS training, respectively.

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Descriptive study of drug-drug interactions attributed to prescriptions written upon discharge from the emergency department

Cited by 7 publications

References 15 publications

Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department—A Retrospective Cohort Study

Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department—A Retrospective Cohort Study

Emergency department admissions induced by drug–drug interactions in the elderly: A cross‐sectional study

Factors associated with a basic common drug-drug interaction knowledge among emergency department medical personnel

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