ToxicologyPolypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department*,**,*
Introduction
Adverse drug-related events (ADREs) present a challenging and expensive public health problem. They account for 3% to 23% of hospital admissions, prolong hospital stays, and increase morbidity and mortality.1, 2 In the hospital environment, physicians and nurses have been estimated to detect only between 5% and 15% of ongoing ADREs when systematic computer-surveillance tools or dedicated personnel are not available.2, 3 An emergency department–based study found that emergency physicians underappreciate the frequency and significance of ADREs. They did not routinely screen for ADREs and medication interactions but added 1 or more new medications to preexisting regimens in 47% of visits and were not more careful in prescribing to high-risk patients.4
We found 4 studies examining the frequency of drug-related illness as a cause of ED presentation.5, 6, 7, 8 These studies report ADREs in 0.86% to 4.3% of all adults presenting to the ED. None of the studies focused on the elderly or other high-risk patient groups, one omitted important causes of ADREs,6 and another did not use a standardized approach for ADRE detection.8 The purpose of this study was to describe the degree of polypharmacy and the frequency of recognized ADREs and PADIs by using standardized detection tools in a population of elderly patients presenting to the ED.
Section snippets
Materials and methods
A retrospective chart review was performed at Sir Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec, Canada. This is a 637-bed university adult teaching hospital with an annual ED census of 55,000 patient visits. We randomly selected 300 visits from a register of all visits to our ED between January 1 and December 31, 1998, made by patients 65 years of age and older. This was a pilot study to set the groundwork for a larger prospective study, and as such, the selection of 300
Results
Of the 300 selected patient visits, 8 were excluded because none of the medications could be identified, 5 because the patients left before evaluation by the ED physician, 3 because the charts could not be found by medical records, and 1 because the ED diagnosis was missing. This left 283 patient visits for analysis. In 20 of the remaining 283 charts, 1 or 2 of the medications could not be identified. Either the compound name could not be found in the Compendium of Pharmaceuticals and
Discussion
We report high rates of medication use consistent with those found by previous investigators. In our sample, 90.8% of patients were taking daily prescription or over-the-counter medication. This is slightly higher than rates previously reported for community-dwelling ambulatory elderly patients.12, 13 The average number of medications consumed daily by our patients was 4.2. This is higher than previous estimates for the community-dwelling elderly population (ie, 2 to 3) but lower than rates for
Acknowledgements
Author contributions: All authors participated actively in the conception of this project. The study was designed by CMH with significant input from JD, MA, and AC. The study proposal was drafted by CMH and reviewed by JD, MA, and AC. Data were acquired and processed by CMH under the supervision of JD. Statistical analysis was performed by AC and CMH. All authors were involved in the interpretation of the study results. CMH drafted the article. It was revised for intellectual content by JD, MA,
References (16)
Drug-related hospital admissions
Ann Pharmacother
(1993)- et al.
Adverse drug events in hospitalized patients
JAMA
(1997) - et al.
Incidence of adverse drug events and potential adverse drug events
JAMA
(1995) - et al.
Potential adverse drug interactions in the emergency room. An issue in the quality of care
Ann Intern Med
(1990) - et al.
Drug-related illness in the emergency department patients
Am J Health Syst Pharm
(1996) - et al.
Adverse drug reaction surveillance in an emergency room
Am J Hosp Pharm
(1993) - et al.
Medication misadventures resulting in emergency department visits at an HMO medical center
Am J Health Syst Pharm
(1996) - et al.
Suspected adverse drug events requiring emergency department visits or hospital admissions
Eur J Clin Pharmacol
(1999)
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Author contributions are provided at the end of this article.
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Supported by the Emergency Department of the Sir Mortimer B. Davis-Jewish General Hospital.
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Address for reprints: Corinne Mich`ele Hohl, MD, c/o Dr. Afilalo's office, Sir Mortimer B. Davis-Jewish General Hospital, 3755 Cote Ste. Catherine, Montreal, Quebec, Canada, H3T 1E2; 514-340-8222 ext. 4579; E-mail [email protected].