Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention.
BACKGROUND
Medications represent a major cause of harm and are costly for hospitalized patients, but more is known about these issues in large academic hospitals than in smaller hospitals.


OBJECTIVE
To assess the incidence of adverse drug events (ADEs) in six community hospitals.


METHODS
Multicenter, retrospective cohort study.


METHODS
Six Massachusetts community hospitals with 100 to 300 beds.


METHODS
From 109,641 adult patients hospitalized from January 2005 through August 2006, a random sample of 1,200 patients was drawn, 200 per site.


METHODS
ADEs and preventable ADEs.


METHODS
Presence of an ADE was evaluated using an adaptation of a trigger instrument developed by the Institute for Health Care Improvement. Independent reviewers classified events by preventability, severity, and potential for preventability by computerized physician order entry (CPOE).


RESULTS
A total of 180 ADEs occurred in 141 patients (rate, 15.0/100 admissions). Overall, 75% were preventable. ADEs were rated as serious in 49.4% and life threatening in 11.7%. Patients with ADEs were older (mean age, 74.6 years, p < 0.001), more often female (60.3%, p = 0.61), and more often Caucasian (96.5%, p < 0.001) than patients without ADEs. Of the preventable ADEs, 81.5% were judged potentially preventable by CPOE.


CONCLUSIONS
The incidence of ADEs in these community hospital admissions was high, and most ADEs were preventable, mostly through CPOE. These data suggest that CPOE may be beneficial in this setting.
Hug
Balthasar L
BL
Division of General Internal Medicine, Brigham and Women's Hospital, Brigham Circle, 1620 Tremont St., 3rd Floor, Boston, MA, 02120-1613, USA.
Witkowski
Daniel J
DJ
Sox
Colin M
CM
Keohane
Carol A
CA
Seger
Diane L
DL
Yoon
Catherine
C
Matheny
Michael E
ME
Bates
David W
DW
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000639:trends*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006764:Hospitals, Community / Q000379:methods / Q000639:trends*; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000639:trends*; D008508:Medication Errors / Q000517:prevention & control / Q000639:trends; D008510:Medication Systems, Hospital / Q000639:trends*; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult