December 05, 2016
According to a recent study and editorial in JAMA, in order to decrease the number of emergency department (ED) visits for adverse drug events, an estimated 4 per 1000 individuals in 2013 and 2014, increased communication between ED physicians and the patients primary care team is needed.
“Adverse drug events are the most common cause of iatrogenic harm in health care and have recently received attention in national patient safety initiatives,” Nadine Shehab, PharmD, MPH, of the division of healthcare quality promotion at the Centers for Disease Control and Prevention, and colleagues wrote in the study. “Improving recognition of adverse drug events by ED physicians is certainly important, but in the interim there is ample opportunity to improve patient safety by focusing attention on the adverse drug events consistently found to be common, serious, and measurable.”
According to the study, researchers approximately 27.3% of recorded adverse drug event-related ED visits resulted in hospitalization. Patients who were 65 years or older accounted for 34.5% of ED visits for adverse drug events, and also had the highest hospitalization rate (43.6%).
The majority of ADE ED visits, among adults, was attributed to anticoagulants, antibiotics, medications for disabilities and opioids. Among children, antibiotics and neuropsychiatric agents were among the most common causes of ED visits for adverse drug events.
In an accompanying editorial, Chad Kessler,MD, of the Durham VA Medical Center, and colleagues wrote that more than 10% of patients in the United States are prescribed 5 or medications. They noted that “it is virtually impossible to take 5 medications exactly as directed, and only an estimated 50% of patients take their medications as prescribed, regardless of the number of prescribed medications.”
In order to prevent, identify, and address adverse drug events, greater involvement and integration of pharmacists, use of medication reconciliations, and the inclusion of patients and their caregivers in medication planning is required. The editorial noted that a typical medication change in the ED is brief and with an anxious patient—generally without input or records from the patients’ primary care or specialty care clinician. In order to safe accomplish medication reconciliation, the authors suggest, “clear communication with patients about the benefits and risks of prescribed medications, explicitly defined methods for reevaluating their need, and means for communicating with the patient’s primary care or specialty care team, all of which are extremely challenging to complete in a rigorous manner during a brief ED visit.”
“Changes are needed across the US health care system to assign the role of primary responsibility to a single clinician or a core group for each patient and ensure the means for easily and effectively communicating what should be a deliberate process of starting, monitoring, and discontinuing prescribed medications across multiple clinicians, caregivers, and health care settings,” Dr. Kessler and colleagues wrote.
Further research is required to determine how to best leverage the existing system to improve the safety of the process of starting, monitoring, and discontinuing patient medication use. With proper collaboration, an integrated health care system can help lead the way through improved care coordination and transition of care models.
“Collaboration is needed among physicians and other health professionals in primary care, specialty care, pharmacy, and emergency medicine to answer these questions in the quest for safer models of patient care,” Dr Kessler and colleagues concluded. “Furthermore, this collaboration across health care locations and the continuum of care will affect how much benefit or harm patients receive from prescribed medications.”
Kessler C, Ward MJ, McNaughton CD. Reducing Adverse Drug Events The Need to Rethink Outpatient Prescribing [published November 22/29 2016]. JAMA. 2016;316(20):2115-2125. doi:10.1001/jama.2016.16201.
Shehab N, Lovegrove MC, Geller AI, et al. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014 [published November 2016]. JAMA. 2016;316(20):2115-2125. doi:10.1001/jama.2016.16201.