Development and validation of the Adverse Inpatient Medication Event model (AIME)

Abstract

Aims Medication harm has negative clinical and economic consequences, contributing to hospitalisation, morbidity and mortality. The incidence ranges from 4 to 14%, of which up to 50% of events may be preventable. A predictive model for identifying high‐risk inpatients can guide a timely and systematic approach to prioritisation. The aim of this study is to develop and internally validate a risk prediction model for prioritisation of hospitalised patients at risk of medication harm. Methods A retrospective cohort study was conducted in general medical and geriatric specialties at an Australian hospital over six months. Medication harm was identified using International Classification of Disease (ICD‐10) codes and the hospital's incident database. Sixty‐eight variables, including medications and laboratory results, were extracted from the hospital's databases. Multivariable logistic regression was used to develop the final risk model. Performance was evaluated using area under the receiver operative characteristic curve (AuROC) and clinical utility was determined using decision curve analysis. Results The study cohort included 1982 patients with median age 74 years, of which 136 (7%) experienced at least one adverse medication event(s). The model included: length of stay, hospital re‐admission within 12 months, venous or arterial thrombosis and/or embolism, ≥ 8 medications, serum sodium < 126 mmol/L, INR > 3, anti‐psychotic, antiarrhythmic and immunosuppressant medications, and history of medication allergy. Validation gave an AuROC of 0.70 (95% CI: 0.65–0.74). Decision curve analysis identified that the AIME may be clinically useful to help guide decision making in practice. Conclusion We have developed a predictive model with reasonable performance. Future steps include external validation and impact evaluation.

Identifying medication harm in hospitalised patients: a bimodal, targeted approach

“…Mortality, secondary to medication harm, is reported at 0.3% of all hospital patients. 3 , 4 Recent local studies in two Australian hospitals linked medication harm to anticoagulants, insulin and antihypertensives, 5 , 6 which is similar to findings from other health systems. 7 , 8 …”

“…In response there has been a flurry of publications on predictive modelling to help with early detection and prediction of those at high risk. 5 , 9 – 11 …”

Clinical usefulness of prediction tools to identify adult hospitalized patients at risk of drug‐related problems: A systematic review of clinical prediction models and risk assessment tools

“…Of the 21 studies, eight involved risk assessment tools 38,40,42,43,[56][57][58][59] and 13 clinical prediction models. 15,[32][33][34][35][36][37]39,41,[60][61][62][63] Among the risk assessment tool studies, four described the development of new tools, 38,40,42,43 three detailed validation process 56,57,59 and one assessed the impact of using the tools on clinical outcomes. 58 Of the 13 studies of clinical prediction models, 10 were model development, 15,[33][34][35][36][37]39,41,60,61 and three externally validated models.…”

The right time and place: the need for seven‐day pharmacist service models

“…62 Coupled with the provision of extended pharmacist services, to ensure best use of pharmacist resources, targeting patients at high risk of medication harm, for timely medication reconciliation, review and post-discharge follow-up is essential in assisting with providing timely care, where it is needed most. 63 There are now riskprediction tools to assist pharmacists with identification of high-risk patients. 63 This must be combined with high-quality care delivered by competent pharmacists working in collaboration with prescribers, an ethos now deemed essential to the future of clinical pharmacy.…”

“…63 There are now riskprediction tools to assist pharmacists with identification of high-risk patients. 63 This must be combined with high-quality care delivered by competent pharmacists working in collaboration with prescribers, an ethos now deemed essential to the future of clinical pharmacy. This is underpinned by the International Pharmaceutical Federation Workforce Development Goals 64 and the Society of Hospital Pharmacists of Australia's Residency Programme, which use a comprehensive framework to assist early career pharmacists advance their competence.…”