Prospective evaluation of adverse drug interactions in the emergency department

Herr, Robert D; Caravati, E. Martin; Tyler, Linda S.; Iorg, Edward; Linscott, M. Scott

doi:10.1016/s0196-0644(05)81897-9

Cited by 53 publications

(45 citation statements)

References 7 publications

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“…In a prospective study, Herr et al [17] examined medications being used by all patients at admission to the emergency department and medications added by emergency department physicians. Medications were entered into a drug interaction program to screen for potential interactions.…”

Section: Emergency Department Visitsmentioning

confidence: 99%

Understanding and preventing drug interactions in elderly patients

Delafuente

2003

Critical Reviews in Oncology/Hematology

161

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Section: Emergency Department Visitsmentioning

confidence: 99%

Understanding and preventing drug interactions in elderly patients

Delafuente

2003

Critical Reviews in Oncology/Hematology

161

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“…97 They found that of 199 visits, 26% of ED patients were exposed to potential adverse drug interactions and 3% had clinically significant responses as determined by a three-member physician review panel. Using a retrospective design, Beers et al revealed a 10% rate of exposure to potential adverse drug interactions among ED patients who received at least one prescription.…”

Section: Teaching About Errormentioning

confidence: 99%

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Schenkel

2000

Academic Emergency Medicine

133

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Abstract. An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.

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“…interactions, [20][21][22] and one including drug-disease interactions. 23 These have identified high-risk groups, such as elders [21][22][23] and those taking multiple medications.…”

Section: Langdorf Et Al • Drug Interactions In the Edmentioning

confidence: 99%

“…23 These have identified high-risk groups, such as elders [21][22][23] and those taking multiple medications. 22,23 Underlying these studies is the assumption that the computer does a better job than the physician, but to the best of our knowledge, this has never been systematically assessed. Furthermore, while potential drug-drug interactions have been studied, we believe the incidence of potential interactions between drugs and ethanol or laboratory tests have not been quantified.…”

Section: Langdorf Et Al • Drug Interactions In the Edmentioning

confidence: 99%

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Physician versus Computer Knowledge of Potential Drug Interactions in the Emergency Department

Langdorf

Fox

Marwah

et al. 2000

Academic Emergency Medicine

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Abstract. Introduction: Proliferation of Food and Drug Administration-approved drugs makes it impossible for emergency medicine (EM) faculty to stay current on potential interactions between drugs, and with diseases, laboratory tests, and ethanol. A computer database may augment physician knowledge. Objectives: To compare the performance of EM faculty and an ''expert'' emergency physician (EP) with that of a criterion standard computer database in identifying potential drug interactions, and to report the incidence of drug-ethanol and drug-laboratory test interactions. Methods: This was a retrospective review of 276 emergency department charts for drug, ethanol, lab, and medical history. Evaluation by both EM faculty and an ''expert'' EP of patient history was done to identify potential interactions, and comparison with the Micromedex Drug-Reax database for potential interactions (graded minor, moderate, or major) was made. Clinical significance of potential interactions was judged by a second EM faculty member. Results: Seventeen percent of the patients had potential drug-drug interactions, and 25% of these were judged to be clinically significant. Up to 52% of the patients had potential drug-ethanol interactions, while 38% of the patients could have potential druglab interactions. Sensitivity, specificity, and positive and negative predictive values of the EM faculty for potential drug-drug interactions compared with the computer were poor, at 14%, 58%, 6%, and 23%, respectively. The corresponding values for the ''expert'' EP were 25%, 86%, 26%, and 85%. The ''expert'' EP was statistically better than the EM faculty, but still less sensitive and predictive than the computer. Conclusions: A computer can aid the physician in avoiding potential drug interactions. Prospective validation of these findings should be done.

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Prospective evaluation of adverse drug interactions in the emergency department

Cited by 53 publications

References 7 publications

Understanding and preventing drug interactions in elderly patients

Understanding and preventing drug interactions in elderly patients

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Physician versus Computer Knowledge of Potential Drug Interactions in the Emergency Department

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