Preventable adverse drug events in a hospital Emergency Department

Objective. To determine the incidence and evaluate the preventability of ad verse drug events (ADE) associated with visits to the Emergency Department at our hospital and subsequent hospital admissions. Methods. A six-month ob servational study was conducted at an Emergency Department in a University Teaching Hospital (October 15th, 1995, to April 15th, 1996). The parameters influencing the preventability were identified by means of a multivariate logistic regression analysis. Results. a total of 776 ADEs (2.25%) were det ected out of a total of 33,975 patients attended at the Emergency Departmen t; 178 patients were admitted. a total of 322 cases (43.3%) were classified as preventable and were graded as mild (37.1%), moderate (32.5%), severe ( 27.4%), and fatal (3%). The logistic regression analysis showed that preven tability was related to drugs with a narrow therapeutic index (NTI) (OR: 10 .12;. 95%CI: 5.36-19.07), type A ADE (OR: 4.65; 95%CI: 2.79-7.78), age grea ter than or equal to 65 years (OR: 3.04; 95%CI: 2.13-4.34) and self-adminis tered medication (OR: 2.2; 95%CI: 1.32-3.65). Among admitted patients, oral anticoagulants, NSAIDs, digoxin, diuretics, and insulin caused adverse eve nts which were considered as preventable in more than 50% of cases. The err ors most frequently associated with preventable ADEs included inappropriate therapy monitoring (22.5%), increased doses with NTI drugs (22.3%), absenc e of preventive therapy (14.3%), excessive dose according to patient's char acteristics (13.4%), and inappropriate self-administered medication (10%). Conclusions. The incidence of preventable ADEs (medication errors) is high anal its severity is higher than that of non-preventable ADEs. A prompt dev elopment and implementation of measures leading to avoiding prescription er rors and inappropriate treatment monitoring, the factors identified as resp onsible for preventable ADEs, is clearly warranted.