Incidence and preventability of adverse drug events in nursing homes
Incidence and preventability of adverse drug events in nursing homes
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DOI：
10.1016/s0002-9343(00)00451-4
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发表时间：
2000-08-01
影响因子：
5.9
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Gurwitz, JH;Field, TS;Bates, DW
目得：药物不良事件，特别是那些可能是可以预防的，是对疗养院药物使用最严重的关注。我们研究了不良药物事件和潜在的不良药物事件的发生率和可预防性在nursinghomes.METHODS：我们进行了一项队列研究的所有长期护理居民的18个社区为基础的疗养院在马萨诸塞州在12个月的观察期。潜在的药物相关事件被发现的刺激自我报告的护理之家的工作人员和定期审查记录的护理之家的居民训练有素的护士和药剂师的调查。每起事件均由2名独立的医生审查员使用结构化隐式审查流程，根据其是否构成药物不良事件或潜在药物不良事件（可能造成伤害，但由于偶然性或因为检测到而未造成伤害）、事件的严重程度（显著、严重、危及生命或致死性）以及是否可预防进行分类。重要事件的例子包括非荨麻疹性皮疹、无骨折的福尔斯、不需要输血或住院的出血和过度镇静;严重事件的例子包括荨麻疹、骨折的福尔斯、需要输血或住院的出血和谵妄。在对18家参与的养老院的28,839名养老院住院医生进行为期一个月的观察期间，确定了546例药物不良事件（1.89/100住院医师月）和188例潜在药物不良事件（0.65/100住院医师月）。在药物不良事件中，1例为致死性，31例（6%）危及生命，206例（38%）为严重，308例（56%）为显著。总体而言，51%的药物不良事件被判定为可预防的，包括238起致命性、危及生命或严重事件中的171起（72%）和308起重大事件中的105起（34%）（P < 0.001）。导致可预防的药物不良事件的错误最常发生在订购和监测阶段;转录，分发和管理中的错误不太常见。精神活性药物（抗精神病药、抗抑郁药和镇静剂/催眠药）和抗凝剂是与可预防的药物不良事件相关的最常见药物。神经精神事件是最常见的类型的可预防的药物不良事件。结论：药物不良事件是常见的，往往是可以预防的，在疗养院。更严重的药物不良事件更有可能是可以预防的。预防策略应针对药学服务的订购和监测阶段。美国医学杂志2000;109：87-94。(C)2000年出版，Excerpta Medica，Inc.
PURPOSE: Adverse drug events, especially those that may have been preventable, are among the most serious concerns about medication use in nursing homes. We studied the incidence and preventability of adverse drug events and potential adverse drug events in nursing homes.METHODS: We performed a cohort study of all long-term care residents of 18 community-based nursing homes in Massachusetts during a 12-month observation period. Potential drug-related incidents were detected by stimulated self-report by nursing home staff and by periodic review of the records of nursing home residents by trained nurse and pharmacist investigators. Each incident was classified by 2 independent physician-reviewers, using a structured implicit review process, by whether or not it constituted an adverse drug event or potential adverse drug event (those that may have caused harm, but did not because of chance or because they were detected), by the severity of the event (significant, serious, life-threatening, or fatal), and by whether it was preventable. Examples of significant events included nonurticarial rashes, falls without associated fracture, hemorrhage not requiring transfusion or hospitalization, and oversedation; examples of serious events included urticaria, falls with fracture, hemorrhage requiring transfusion or hospitalization, and delirium.RESULTS: During 28,839 nursing home resident-months of observation in the 18 participating nursing homes, 546 adverse drug events (1.89 per 100 resident-months) and 188 potential adverse drug events (0.65 per 100 resident-months) were identified. Of the adverse drug events, 1 was fatal, 31 (6%) were life-threatening, 206 (38%) were serious, and 308 (56%) were significant. Overall, 51% of the adverse drug events were judged to be preventable, including 171 (72%) of the 238 fatal, life-threatening, or serious events and 105 (34%) of the 308 significant events (P < 0.001). Errors resulting in preventable adverse drug events occurred most often at the stages of ordering and monitoring; errors in transcription, dispensing, and administration were less commonly identified. Psychoactive medications (antipsychotics, antidepressants, and sedatives/hypnotics) and anticoagulants were the most common medications associated with preventable adverse drug events. Neuropsychiatric events were the most common types of preventable adverse drug events.CONCLUSIONS: Adverse drug events are common and often preventable in nursing homes. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the ordering and monitoring stages of pharmaceutical care. Am J Med. 2000;109:87-94. (C) 2000 by Excerpta Medica, Inc.