Limits...
Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy.

Klopotowska JE, Wierenga PC, Stuijt CC, Arisz L, Dijkgraaf MG, Kuks PF, Asscheman H, de Rooij SE, Lie-A-Huen L, Smorenburg SM, WINGS Study Gro - PLoS ONE (2013)

Bottom Line: Several strategy related aspects, as well as setting/study specific aspects, may have contributed to the results gained.The results regarding pADEs can be used to design tailored interventions to effectively reduce harm caused by medication errors.Improvement of the inter-rater reliability of a PCR remains challenging.

View Article: PubMed Central - PubMed

Affiliation: Department of Hospital Pharmacy, Academic Medical Center, Amsterdam, the Netherlands. j.e.klopotowska@amc.nl

ABSTRACT

Background: Older patients are at high risk for experiencing Adverse Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in these vulnerable patients, hospitals first need to measure the occurrence of ADEs, especially those that are preventable. However, data on preventable ADEs (pADEs) occurring during hospitalization in older patients are scarce, and no 'gold standard' for the identification of ADEs exists.

Methodology: The study was conducted in three hospitals in the Netherlands in 2007. ADEs were retrospectively identified by a team of experts using a comprehensive and structured patient chart review (PCR) combined with a trigger-tool as an aid. This ADE identification strategy was applied to a cohort of 250 older hospitalized patients. To estimate the intra- and inter-rater reliabilities, Cohen's kappa values were calculated.

Principal findings: In total, 118 ADEs were detected which occurred in 62 patients. This ADE yield was 1.1 to 2.7 times higher in comparison to other ADE studies in older hospitalized patients. Of the 118 ADEs, 83 (70.3%) were pADEs; 51 pADEs (43.2% of all ADEs identified) caused serious patient harm. Patient harm caused by ADEs resulted in various events. The overall intra-rater agreement of the developed strategy was substantial (κ = 0.74); the overall inter-rater agreement was only fair (κ = 0.24).

Conclusions/significance: The ADE identification strategy provided a detailed insight into the scope of ADEs occurring in older hospitalized patients, and showed that the majority of (serious) ADEs can be prevented. Several strategy related aspects, as well as setting/study specific aspects, may have contributed to the results gained. These aspects should be considered whenever ADE measurements need to be conducted. The results regarding pADEs can be used to design tailored interventions to effectively reduce harm caused by medication errors. Improvement of the inter-rater reliability of a PCR remains challenging.

Show MeSH

Related in: MedlinePlus

Flow-chart of the Adverse Drug Events identification and assessment processes.1 CPOE-CDS - Computer Physician Order Entry with Clinical Decision Support. 2 ADEs - Adverse Drug Events.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3733642&req=5

pone-0071045-g001: Flow-chart of the Adverse Drug Events identification and assessment processes.1 CPOE-CDS - Computer Physician Order Entry with Clinical Decision Support. 2 ADEs - Adverse Drug Events.

Mentions: A flowchart of ADE identification and assessment strategy is shown in Figure 1. No attempt was made to assess sensitivity or specificity of this strategy, as a clear “gold standard” for ADE identification is lacking [20], [22]–[27].


Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy.

Klopotowska JE, Wierenga PC, Stuijt CC, Arisz L, Dijkgraaf MG, Kuks PF, Asscheman H, de Rooij SE, Lie-A-Huen L, Smorenburg SM, WINGS Study Gro - PLoS ONE (2013)

Flow-chart of the Adverse Drug Events identification and assessment processes.1 CPOE-CDS - Computer Physician Order Entry with Clinical Decision Support. 2 ADEs - Adverse Drug Events.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3733642&req=5

pone-0071045-g001: Flow-chart of the Adverse Drug Events identification and assessment processes.1 CPOE-CDS - Computer Physician Order Entry with Clinical Decision Support. 2 ADEs - Adverse Drug Events.
Mentions: A flowchart of ADE identification and assessment strategy is shown in Figure 1. No attempt was made to assess sensitivity or specificity of this strategy, as a clear “gold standard” for ADE identification is lacking [20], [22]–[27].

Bottom Line: Several strategy related aspects, as well as setting/study specific aspects, may have contributed to the results gained.The results regarding pADEs can be used to design tailored interventions to effectively reduce harm caused by medication errors.Improvement of the inter-rater reliability of a PCR remains challenging.

View Article: PubMed Central - PubMed

Affiliation: Department of Hospital Pharmacy, Academic Medical Center, Amsterdam, the Netherlands. j.e.klopotowska@amc.nl

ABSTRACT

Background: Older patients are at high risk for experiencing Adverse Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in these vulnerable patients, hospitals first need to measure the occurrence of ADEs, especially those that are preventable. However, data on preventable ADEs (pADEs) occurring during hospitalization in older patients are scarce, and no 'gold standard' for the identification of ADEs exists.

Methodology: The study was conducted in three hospitals in the Netherlands in 2007. ADEs were retrospectively identified by a team of experts using a comprehensive and structured patient chart review (PCR) combined with a trigger-tool as an aid. This ADE identification strategy was applied to a cohort of 250 older hospitalized patients. To estimate the intra- and inter-rater reliabilities, Cohen's kappa values were calculated.

Principal findings: In total, 118 ADEs were detected which occurred in 62 patients. This ADE yield was 1.1 to 2.7 times higher in comparison to other ADE studies in older hospitalized patients. Of the 118 ADEs, 83 (70.3%) were pADEs; 51 pADEs (43.2% of all ADEs identified) caused serious patient harm. Patient harm caused by ADEs resulted in various events. The overall intra-rater agreement of the developed strategy was substantial (κ = 0.74); the overall inter-rater agreement was only fair (κ = 0.24).

Conclusions/significance: The ADE identification strategy provided a detailed insight into the scope of ADEs occurring in older hospitalized patients, and showed that the majority of (serious) ADEs can be prevented. Several strategy related aspects, as well as setting/study specific aspects, may have contributed to the results gained. These aspects should be considered whenever ADE measurements need to be conducted. The results regarding pADEs can be used to design tailored interventions to effectively reduce harm caused by medication errors. Improvement of the inter-rater reliability of a PCR remains challenging.

Show MeSH
Related in: MedlinePlus