Analysis of adverse drug reactions for preventability
Analysis of adverse drug reactions for preventability
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DOI：
10.1111/j.1742-1241.2006.01130.x
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发表时间：
2007-01-01
影响因子：
2.6
通讯作者：
Boothby, L. A.
中科院分区：
文献类型：
--
作者：
Ducharme, M. M.;Boothby, L. A.
尽管我们机构在过去 12 年中对所有药物不良反应 (ADR) 调查的可预防性标准进行了评估，但尚未对数据进行系统评估。该项目分析了之前收集的可预防性数据，以确定流程改进的潜在领域。进行了 3 年的回顾性分析。所有 ADR 均按药物、药物类别、严重程度、因果关系概率和可预防性进行分类。对涉及可预防性的因素进行了评估和统计。使用描述性统计来分析数据。大多数 ADR 发生在入院之前。在门诊环境中，与其他药物类别相比，抗凝剂和抗惊厥药与更多可预防的 ADR (pADR) 相关，其次是强心剂和非甾体抗炎药 (NSAID)。对于住院患者发生的不良反应，抗生素和阿片类药物与大约一半的不良反应有关。入院前与 ADR 最常见相关的可预防性类别是存在有毒药物水平和药物间相互作用，而剂量、途径或频率不当是住院患者 ADR 最常见的可预防性类别。在住院和门诊环境中，大多数 pADR 的严重程度均为中等。 pADR 涉及的药物和药物类别在住院和门诊环境中有所不同。可预防性类别也因环境而异。大多数 pADR 发生在进入我们的医疗保健系统之前。这对实施流程变更以减少 pADR 提出了挑战，因为社区中的患者不在我们的控制范围内。
Although preventability criteria have been assessed for all adverse drug reactions (ADRs) investigated at our institution over the past 12 years, a systematic evaluation of the data had not been performed. This project analysed preventability data previously collected to identify the potential areas for process improvements. A 3-year retrospective analysis was performed. All ADRs were categorised by drug, drug class, severity, probability of causality and preventability. Factors involved in preventability were assessed and tallied. Descriptive statistics was used to analyse the data. Most ADRs occurred prior to admission. In the outpatient setting, anticoagulants and anticonvulsants were associated with more preventable ADRs (pADRs) than other drug classes, followed by cardiotonic agents and non-steroidal anti-inflammatory drugs (NSAIDs). For ADRs that occurred in hospitalised patients, antibiotics and opiates were associated with approximately half of all pADRs. The preventability categories most frequently associated with ADRs prior to admission were presence of a toxic drug level and drug-drug interactions, while inappropriate dose, route or frequency was the most common preventability category for inpatient ADRs. The majority of pADRs were moderate in severity in both the in- and outpatient settings. Drugs and drug classes involved in pADRs differ in the in- and outpatient settings. Preventability categories also differ by setting. Most pADRs occur prior to admission in our healthcare system. This presents a challenge in terms of implementing the process changes to reduce the pADRs, as patients in the community are outside our control.