ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

Isabelle Nguyen
Christen Enos
Advanced Writing in Health Professions
November 13, 2015
Adverse Drug Events: Analysis and Prevention
Context Note
This is a report on adverse drug events. It is specifically discussing the percentage
of adverse drug events that are preventable and how it affects the population. Its purpose is to
draw attention to the occurrence and prevalence of adverse drug reactions and the fact that of
those reported ADEs, a large percentage is actually preventable. This document is for health care
professionals such as nurses, physicians and pharmacists to recognize that there is a problem and
for them to help find solutions to the issue or implement solutions. To know understand this
document, readers would need to have a rudimentary understanding of drugs, how they could
react with each other and affect the organs. A way to disseminate the information would be a
medical journal that healthcare professionals would read.
Introduction
Adverse drug events annually affect roughly 2 million hospital patients and account for
3.5 million physician office visits. Approximately one third of all adverse events in a hospital is
an adverse drug event. All of these statistics come from reported adverse drug events. However
there are many that go unreported in outpatient and inpatient care as well as simply unnoticed
entirely. The percentage of preventable adverse drug events in all cases of adverse drug events is

ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

unacceptably high, and even then the actual percentage is higher than what is shown due to the
number of cases that are not reported.
Adverse Drug Events
The term adverse drug event is a large umbrella term that covers any adverse event that is related
to drugs. It includes adverse drug reactions and preventable adverse drug reactions. Adverse drug
reactions can be any negative reaction of a patient to a medication. It comes in varying stages of
intensity, from unexpected to serious. Serious adverse reactions are defined as Any untoward
medical occurrence that at any dose results in death, requires hospital admission or prolongation
of existing hospital stay, results in persistent or significant disability/incapacity, or is life
threatening (Edwards 2000). There are varying amounts of occurrences for adverse drug events
in outpatient and inpatient care. The numbers that are recorded however are not completely
accurate for a variety of reasons. While the information is fairly accurate, there are patches of
missing data because not all cases are reported for a number of reasons. In a survey of pharmacy
students, a fair number expressed the knowledge that adverse drug events have to be reported to
FDA, but roughly 70% are unclear of how to do so. When given a sheet with 8 questions
regarding the method of reporting a serious adverse drug event, less than 70 percent were able to
get 4 questions correct. In addition to not having clear methods of reporting adverse drug events,
some of the students described fears for reporting the events. Some of the students expressed the
belief that reporting serious ADEs could result in negative outcomes including increased risk of
malpractice, compromised relationships with physicians, broken trust with patients, and
disruption of the normal workflow, and was time consuming (Gavaza 2012). Keeping in mind
that the percentages given are possibly higher in actuality increases the gravity of the
occurrences of adverse drug events.

ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

Preventable Adverse drug events

While there are some unavoidable adverse events related to drugs, about 45 percent of all
adverse events were preventable, under the label, medication errors. Medication errors can be
split further into two types of errors, error by action and error by omission. Error by action has
any different causes, such as incorrect dosage, incorrect medication, or accidental adverse drug
interaction. Error by omission is caused by failure on either the part of the patient or the health
care provider (Thomsen 2007). The patient can contribute to the error by not taking the
medication as directed or not informing pharmacists or physicians about additional medications.
Physicians and pharmacists can contribute by not following up on a patient to ensure they are
taking the medication correctly or by not prescribing a necessary medication (Troyen 1991).
Another factor that adds to the reoccurring medication errors is the chain of command in
hospitals. The orders for drugs passes through many terminals and people and are sometimes
misread and slipped through the cracks. A large majority are caught by pharmacists, but there are
many that are able to harm the patients.
Adverse Drug events: 3 month study results
In a study that utilized a population of 4970 individuals, both inpatient and outpatient
care, with only 49 percent of which had health care encounters within 3 months before the study,
12 percent of the entire population had an adverse drug event. The distribution of adverse drug
events varied across the age groups, being more prevalent in the older age groups. 38.8 percent
of the adverse drug events were deemed preventable. Of the adverse drug events that occurred
during this test, 9.5 percent of them were serious. Further analysis states that of the serious
adverse drug events, 55.9 percent, over half, were actual preventable (Hakkarainen 2014).

ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

Simple innocuous mistakes like increased dosage, or decreased dosage can cause harmful effects
to the patients.
The age group with the highest amount of adverse drug events are 65 years and older. Of
the adverse drug events that occurred in this age group, 132 events were preventable of the 278
(Hakkarainen 2014). This age group of 65 and older has the highest percentage of preventable
adverse drug events, five times and double the other two age groups. This issue with preventable
adverse drug events is that it affects the older population the most, which is soon to be dire as our
society is considered an aging society as the baby boomers are starting to get older. This is the
group that would be most affected by adverse drug events. With the increased geriatric presence
in hospitals, there needs to be changes to try and keep patients as healthy as possible by avoiding
preventable adverse drug events.
Proposed Solutions
To decrease the occurrence of preventable adverse drug events, there are several solutions
that have positive and negative aspects. The first solution comes a study that researched the
effect of a pharmacist in the Intensive Care Unit on the rates of adverse drug events, both
unavoidable and preventable. The study used a control group which would not have a pharmacist
and the test group that did have a pharmacist doing rounds and intervening when necessary. The
results were calculated based on patient admissions and found that having a pharmacist reduced
the rate of preventable drug events by nearly two-thirds, a staggering 66% (Lucien 1999). The
difficulty in implementing this solution would be the change to the usage of the pharmacists
time and integration to the medical team of the Intensive Care Unit. In addition, there would be a
loss of a pharmacist fulfilling the medication orders, which may need to be replaced with a new
hired one which is increased cost. One of the issues of the change would be the logistics of

ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

adding a pharmacist to the teams of the unit since there are multiple physicians doing rounds at
the same time. However in the study, the physicians had 99% recommendation for the changes.
The cost of a preventable ADE, one due to an error, was estimated at $4685.9. For the year
1995, [It was] estimated that 58 ADEs were prevented. At $4685 each, the cost reduction in
this single unit would be approximately $270,000 per year. (Lucien 1999) In addition to helping
catch prescribing errors and warning of negative drug interactions, pharmacists in the study were
able to teach drug safety to the attending nurses and reduce the number of nurses calling the
physicians to have an order corrected. Adding a pharmacist to the medical team in the Intensive
Care Unit would decrease the total rate of adverse drug events which in turn means increased
overall health for the patients.
Another solution would be to increased patient to health care communication. This
solution is geared towards reducing the amount of preventable adverse drug events in outpatient
care. It is harder to keep track of patients in outpatient care and their drug use, which is ideal
situations for a preventable adverse drug event. Some of the adverse drug events could have
prevented had the patient described a symptom that would inform the physician or pharmacist
that the drug was having a negative effect on the patient. In the study using the patients in four
main ambulatory care pharmacies, one patient had an adverse drug event with the symptom of
losing sleep (Tejal 2013). Because he or she did not report it, the continued usage of the
medication ultimate had detrimental effects on the overall health of the patient. Increased followup by pharmacists and physicians would generate an increased amount interaction and
information trading that would wholly be better for the patient, but is very hard to implement due
to the addition work it would require.

ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

Another solution to reduce the amount of adverse drug events would include increased
usage of computerized drug entries for necessary medications. This way, while still allowing
some errors, would decrease the amount of preventable drug events with less time consuming
efforts. In a study comparing the efficiency of three methods of finding adverse drug events, the
usage of computers did not discover the most preventable adverse drug events, but was the most
efficient in terms of human inputted hours. In the study, it compared computer usage, chart
reviews and voluntary reports. It estimated that computer usage required roughly 11 hours, chart
review 55 hours and voluntary reports 5 hours (Ashish 1998). In terms of events caught to hours,
the computer usage was the most efficient in alerting physicians of potential adverse drug events
by allergy, or negative drug interactions.
Adverse drug events are unavoidable though there are ways that we can reduce the
amount of preventable adverse drug events. The percentage of preventable drug events is too
high for the advancements we have made in medicines. While we have increased the length of
life in many people and helped a great deal of others, we should not be complacent and allow
errors to occur, especially when they can be avoided with a little bit more effort and time. There
are solutions that may cost a bit, but the overall increase in public health will be worth the price
in the long run.
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ADVERSE DRUG EVENTS: ANALYSIS AND PREVENTION

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