Drug-Related Problems in Hospitals

Abstract

Problems associated with pharmacotherapy (in particular, medication errors and adverse drug events) are frequent and are associated with increased costs for treatment. Analysis of original publications published between 1990 and 2005 on the topics of medication errors and/or adverse drug events in hospitalised patients, focusing on the frequency of, risk factors for and avoidance of such problems associated with pharmacotherapy, indicated that medication errors occurred in a mean of 5.7% of all episodes of drug administration, but with a high variability among the 35 studies retrieved. This variability was explained by the methods by which medication errors were detected (systematic screening of patients versus chart review or spontaneous reporting) and by the way drugs were administered (intravenously administered drugs are associated with the highest error frequencies). Errors occurred throughout the whole medication process, with administration errors accounting for more than half of all errors. Important risk factors included insufficient pharmacological knowledge of health professionals, errors in the patient charts or documentation by nurses and inadequate pharmacy services.Adverse events or reactions, on the other hand, affected 6.1 patients per 100 hospitalised and also showed a high variability among the 46 studies retrieved. This variability could also be explained by the different methods of assessment of the frequency of adverse drug events or reactions, as well as by the different wards on which the studies were performed. Important risk factors for adverse drug events or reactions included polypharmacy, female sex, drugs with a narrow therapeutic range, renal elimination of drugs, age >65 years and use of anticoagulants or diuretics. Since medication errors are strong risk factors for preventable adverse drug events or reactions, strategies have to be put in place for their reduction. Such strategies include ensuring that all persons involved in the medication process (nurses, pharmacists and physicians) have good pharmacological knowledge, computerisation of the entire medication process, and the engagement of a sufficient number of clinical pharmacists on the wards.

Pharmacogenomic Biomarkers for Improved Drug Therapy—Recent Progress and Future Developments

“…Between 5 and 13% of in-and outpatient experience adverse drug-related events, mostly adverse drug reactions (ADRs) and sub-therapeutic effects of drug therapy [1,2]. Various patient-specific factors, including age, polypharmacy, concomitant diseases, and diet as well as heritable factors contribute to these inter-individual differences with genetic polymorphisms explaining around 20-30% of the inter-individual variability in drug response [3,4].…”

A prospective analysis of the preventability of adverse drug reactions reported in Sweden

“…The frequencies of preventable ADRs vary considerably in different studies. Most studies [6][7][8][9][10] indicate that a substantial proportion of ADRs are in fact preventable. This seems to be the case also for fatal ADRs [11].…”

Adverse drug reactions in internal medicine units and associated risk factors

“…Common factors associated with ADRs are age, sex, number of drugs or comorbidities [5][6][7][8][9][10] .Meanwhile, other important factors such as renal function or pharmacologic counteractions, have not been well studied [1][2][3][4][5][6][7][8][9][10][11][12] . Patients hospitalized in Internal Medicine wards have predisposition of suffering ADRs because they are older, have several comorbidities, and need multiple drugs at hospitalization.…”

“…Patients hospitalized in Internal Medicine wards have predisposition of suffering ADRs because they are older, have several comorbidities, and need multiple drugs at hospitalization. So patients hospitalized at Internal Medicine wards stand for an interesting population for studying ADRs 11 . Frequently these patients have renal insufficiency that can worse during hospitalization because of the disease or condition that is causing the hospitalization.…”