Emergency re‐admissions to hospital due to adverse drug reactions within 1 year of the index admission

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTADRs in hospital patients are a significant burden, though how often ADRs cause re-admission to hospital has not been well documented in the literature. WHAT THIS STUDY ADDS• One fifth of patients re-admitted to hospital within 1 year of discharge from their index admission were re-admitted due to an adverse drug reaction. • Admission to a medical ward, elderly age and prescription of anti-platelet agents or diuretics were identified as risk factors for re-admission due to ADRs.• Since up to 50% of these reactions were possibly avoidable, better methods of medication review in both hospital and primary care, in conjunction with a clinical review, are needed to enable improved prescribing practices that will be essential for improving the benefit-harm balance of medicines. AIMThe proportion of re-admissions to hospital caused by ADRs is poorly documented in the UK. The aim of this study was to evaluate the impact of ADRs on re-admission to hospital after a period as an inpatient. METHODSOne thousand patients consecutively admitted to 12 wards were included. All subsequent admissions for this cohort within 1 year of discharge from the index admission were retrospectively reviewed. RESULTSOf the 1000 patients included, 403 (40.3%, 95% CI 39.1, 45.4%) were re-admitted within 1 year. Complete data were available for 290 (70.2%) re-admitted patients, with an ADR contributing to admission in 60 (20.8%, 95% CI 16.4, 25.6%) patients. Presence of an ADR in the index admission did not predict for an ADR-related re-admission (10.5% vs. 7.2%, P = 0.25), or re-admission overall (47.2% vs. 41.2%, P = 0.15). The implicated drug was commenced in the index admission in 33/148 (22.3%) instances, with 37/148 (25%) commenced elsewhere since the index admission. Increasing age and an index admission in a medical ward were associated with a higher incidence of re-admission ADR. The most frequent causative drugs were anti-platelets and loop diuretics, with bleeding and renal impairment the most frequent ADRs. Over half (52/91, 57.1%) of the ADRs were judged to be definitely or possibly avoidable. CONCLUSIONSOne fifth of patients re-admitted to hospital within 1 year of discharge from their index admission are re-admitted due to an ADR. Our data highlight drug and patient groups where interventions are needed to reduce the incidence of ADRs leading to re-admission.

Réhospitalisations d’origine médicamenteuse : étude pilote dans un service de post-urgences médicales d’un hôpital universitaire français

“…L'étude de Zhang et al [8] avait analysé rétrospectivement les facteurs prédictifs de réhospitalisations pour EIM chez les sujets âgés de plus de 60 ans, suggérant une incidence de 17 %. Une étude prospective au Royaume-Uni [9] en 2010 ayant pour but de déterminer le taux d'incidence de réhospitalisation pour EIM chez les 1000 premiers patients hospitalisés avait estimé ce taux à 17 ‰ patients-année. Notre taux d'incidence de 17,8 ‰ patients-année est donc comparable à notre étude antérieure au CHU de Toulouse et à celle réalisée au Royaume-Uni.…”

“…En fonction de la méthodo-logie (rétrospective ou prospective), la durée de suivi, le mode de recueil ou le service concerné, les résultats sont variables. À ce jour, peu de données concernent la réhospitalisation pour EIM et les données varient selon les méthodes d'étude : 17 % dans les 3 ans suivant la première hospitalisation pour Zhang et al [8], 17 ‰ au Royaume-Uni à travers une étude prospective [9] et 4,2 % au cours d'une autre étude prospective réalisée en Allemagne [10]. Teymoorian et al suggéraient une prévalence de 24,3 % chez les sujets > 80 ans dans le mois suivant la première hospitalisation aux États-Unis [11].…”

Post discharge medicines use review (dMUR) service for older patients: Cost-savings from community pharmacist interventions

“…2,3 Improved discharge information and patient education are core principles for reducing unintentional medication changes, patient harm and hospital re-admissions. 4,5 In the United Kingdom (UK), Medicines Use Reviews (MURs), face-to-face consultations between a patient and their regular community pharmacist, are designed to identify any problems or information needs patients have with medicines and offer solutions.…”

Reduce Readmissions with Pharmacy Programs; USP Updates Heparin Label; Insulin Concentration Rarely Needed on Orders

“…[5][6][7] This includes patient nonadherence to prescribed drug therapy, which by itself leads to treatment failures and wasted resources costing $150 billion annually. 8 A recent study by Budnitz et al 7 identified the drugs involved in 88.3% of emergency hospital admissions of older adults caused by adverse drug events: hematologic, endocrine, cardiovascular, central nervous system, and anti-infective agents.…”