Adverse drug events occurring following hospital discharge
Adverse drug events occurring following hospital discharge
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DOI：
10.1111/j.1525-1497.2005.30390.x
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发表时间：
2005-04-01
影响因子：
5.7
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Forster, AJ;Murff, HJ;Bates, DW
目的：描述药物不良事件（ADEs）的发生率，可预防的ADEs，可改善的ADEs发生后出院及其相关的危险factors.Design：前瞻性队列研究。设置：城市学术健康科学中心。患者：conceptive患者出院回家从一般医疗服务。干预：我们确定出院后约24天的出院后的结果进行了图表审查和电话采访。通过电话访谈，我们确定了新的或恶化的症状，病人的卫生系统的使用，以及护理过程的回忆。由2名内科医生独立判断术后结局。结果：对581例潜在合格患者中的400例进行了评价。400例患者中，45例发生ADE（发生率，11%; 95%置信区间[CI]，8%-14%）。其中，27%是可以预防的，33%是可以改善的。32例患者的损伤严重，6例严重，7例危及生命。如果患者回忆起解释了处方药物的副作用，则发生ADE的可能性较小（OR，0.4; 95% CI，0.2 - 0.8）。皮质类固醇、抗凝剂、抗生素、镇痛剂和心血管药物的ADE风险最高。风险随着处方数量的增加而增加。未能监测是可预防和可改善的ADE的常见原因。出院后，ADE很常见，许多是可以预防或改善的。应讨论药物副作用，干预措施应包括更好地监测和目标患者接受特定药物类别或多种药物。
OBJECTIVE: To describe the incidence of adverse drug events (ADEs), preventable ADEs, and ameliorable ADEs occurring after hospital discharge and their associated risk factors.DESIGN: Prospective cohort study.SETTING: Urban academic health sciences center.PATIENTS: Consecutive patients discharged home from the general medical service.INTERVENTIONS: We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview. Using the telephone interview, we identified new or worsening symptoms, the patient's health system use, and recollection of processes of care. Posthospital outcomes were judged by 2 internists independently.RESULTS: Four hundred of 581 potentially eligible patients were evaluated. Of the 400 patients, 45 developed an ADE (incidence, 11%; 95% confidence interval [CI], 8% to 14%). Of these, 27% were preventable and 33% were ameliorable. Injuries were significant in 32 patients, serious in 6, and life threatening in 7. Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained (OR, 0.4; 95% Cl, 0.2 to 0.8). The risk of ADE per prescription was highest for corticosteroids, anticoagulants, antibiotics, analgesics, and cardiovascular medications. Risk increased with prescription number. Failure to monitor was an especially common cause of preventable and ameliorable ADEs.CONCLUSION. Following discharge, ADEs were common and many were preventable or ameliorable. Medication side effects should be discussed, and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications.