Detection and prevention of medication misadventures in general practice.
BACKGROUND
Adverse drug events are leading categories of iatrogenic patient injury. Development of preventive strategies for general practice setting depends on effective detection of events.


OBJECTIVE
The aim of the study is to compare the strengths and weaknesses of voluntary reporting, chart review and patient survey in measuring medication misadventures in general practice and to analyze the events by severity and preventability, drug groups and patients' and doctors' characteristics, for the formulation of preventive strategies.


METHODS
In the 2-month study period, we applied voluntary report, chart review and patient survey to collect data related to medication misadventures and compared their detection rate.


RESULTS
The chart review demonstrated the highest yield for detecting overall medication misadventures (2.03% medication orders), followed by patient survey (1.46% medication orders) and voluntary reporting (0.52% medication orders). Chart review and patient survey were better than voluntary reporting in uncovering preventable adverse drug events. However, voluntary reporting was pivotal in capturing sentinel events. Beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin and non-steroidal anti-inflammatory drugs had caused 82.0% of all adverse drug events. These events were more common with advanced age of patients, greater number of consultation problems and prescribed drug items. Additional resources implicated were minimal.


CONCLUSIONS
We suggested a complementary approach using chart review and voluntary reporting in measuring and monitoring medication misadventures in general practice. Close monitoring of the events was necessary for older patients, multiple medical problems and poly-pharmacy and for patients using beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin or non-steroidal anti-inflammatory drugs on a long-term basis.
Tam
Ka Wae Tammy
KW
Professional Development and Quality Assurance, Department of Health, Hong Kong. tammy_kwl@hotmail.com
Kwok
Kon Hung
KH
Fan
Yuen Man Cecilia
YM
Tsui
Kwok Biu
KB
Ng
Kwok Keung
KK
Ho
King Yip Anthony
KY
Lau
Kam Tong
KT
Chan
Yuk Chun
YC
Tse
Ching Wan Charmaine
CW
Lau
Cheuk Man
CM
D016907:Adverse Drug Reaction Reporting Systems; D064420:Drug-Related Side Effects and Adverse Reactions; D005194:Family Practice; D019538:Health Care Surveys; D006723:Hong Kong; D006801:Humans; D008485:Medical Audit / Q000379:methods; D008499:Medical Records; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008875:Middle Aged; D012308:Risk Management / Q000379:methods; D035141:Voluntary Programs