Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-28T12:50:55.255Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient-reported adverse drug-related events from emergency department discharge prescriptions

Published online by Cambridge University Press:  21 May 2015

Corinne M. Hohl ,
Riyad B. Abu-Laban ,
Peter J. Zed ,
Jeffrey R. Brubacher ,
Gina Tsai ,
Patricia Kretz ,
Kevin Nemethy  and
Roy A. Purssell
Corinne M. Hohl*
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Peter J. Zed
Affiliation:
Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Capital Health, Halifax, NS Department of Emergency Medicine and College of Pharmacy, Dalhousie University, Halifax, NS
Jeffrey R. Brubacher
Affiliation:
Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
Gina Tsai
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Patricia Kretz
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC
Kevin Nemethy
Affiliation:
Royal College Emergency Medicine Training Program, University of Alberta, Edmonton, Alta.
Roy A. Purssell
Affiliation:
Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC
*
Department of Emergency Medicine, Vancouver General Hospital, 855 West 12th Ave., Vancouver BC V5Z 1M9; chohl@interchange.ubc.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The tolerability of drugs prescribed on emergency department (ED) discharge is unknown. Our objectives were to quantify and describe adverse drug-related events (ADREs) as reported by patients triaged as Canadian Emergency Department Triage and Acuity Scale scores 3, 4 or 5, discharged from the ED with prescriptions.

Methods:

This prospective observational study was a planned substudy of a larger study on adherence to discharge prescriptions. This study was conducted in a tertiary care centre with an annual ED census of 69 000 visits. The primary outcome was the frequency of ADREs reported during a structured telephone questionnaire 2 weeks after ED discharge. An ADRE was deemed to have occurred if the patient reported a symptom consistent with a known ADRE that began and resolved within a plausible time frame after starting and stopping the drug, and if no alternative diagnosis was probable.

Results:

Research assistants contacted 258/301 (85.7%) patients discharged from the ED with a prescription. An ADRE was reported by 54/258 patients (20.9%, 95% confidence interval [CI] 16.4%–26.3%). The most commonly reported ADREs were nausea, constipation and drowsiness. None required hospital admission or caused death. Participants reporting ADREs were not more likely to make an unplanned ED or clinic revisit (crude odds ratio [OR] 1.1, 95% CI 0.6–2.2; adjusted OR 1.2, 95% CI 0.6–2.4).

Conclusion:

Approximately one-fifth of low-acuity patients prescribed medication on discharge from the ED report ADREs, but most of these are neither severe nor associated with an increase in use of health services. Attention to common preventable ADREs, such as opioid-associated constipation, could reduce the rate of ADREs in this population.

Keywords

adverse eventsadverse drug-related eventsemergency medicinepatient safetymedication
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 4 , July 2010 , pp. 331 - 338
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Baker, GR, Norton, PG, Flintoft, V, et al.The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004;170:1678–86.Google Scholar
2.Forster, AJ, Asmis, T, Clark, H, et al.Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital. CMAJ 2004;170:1235–40.CrossRefGoogle Scholar
3.Lazarou, J, Pomeranz, B, Corey, P. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200–5.Google Scholar
4.Zed, PJ, Abu-Laban, RB, Balen, RM, et al.Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 2008;178:1563–9.CrossRefGoogle Scholar
5.Croskerry, P, Sinclair, D. Emergency medicine: A practice prone to error? CJEM 2001;3:271–6.CrossRefGoogle ScholarPubMed
6.Hohl, CM, Abu-Laban, R, Brubacher, J, et al.Adherence to emergency department discharge prescriptions. CJEM 2009;11:131–8.CrossRefGoogle ScholarPubMed
7.Manos, D, Petrie, D, Beveridge, R, et al.Inter-observer agreement using the Canadian Emergency Deparment Triage and Acuity Scale. CJEM 2002;4:16–22.Google Scholar
8.Canadian Pharmacists Association. Compendium of pharmaceuticals and specialties. The Canadian drug reference for health professionals. Ottawa (ON): The Association; 2007. Available: http://www.e-therapeutics.ca/wps/portal/!ut/p/.scr/Login (accessed 2007 Jan. 1).Google Scholar
9.Naranjo, CA, Busto, U, Sellers, EM, et al.A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–45.CrossRefGoogle ScholarPubMed
10.Lanctot, KL, Naranjo, CA. Comparison of the Bayesian approach and a simple algorithm for assessment of adverse drug events. Clin Pharmacol Ther 1995;58:692–8.Google Scholar
11.Hohl, CM, Dankoff, J, Colacone, A, et al.Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001;38:666–71.CrossRefGoogle ScholarPubMed
12.World Health Organization. International drug monitoring: the role of the hospital. Report of a WHO meeting. Geneva: The Organization; 1966. p. 5–24.Google Scholar
13.Hohl, CM, Robitaille, C, Lord, V, et al.Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department. Acad Emerg Med 2005;12:197–205.Google Scholar
14.Kaboli, PJ, Hoth, AB, McClimon, BJ, et al.Clinical pharmacists and inpatient medical care. Arch Intern Med 2006;166:955–64.Google Scholar