Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects.
OBJECTIVE
Evaluate the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting.


METHODS
Randomised prospective study.


METHODS
The study was performed in France in the Paris area, in 16 rehabilitation geriatric centres of APHP (Assistance Publique - Hôpitaux de Paris). Patient capacity per centre varied from 15 to 57 with a total of 526.


METHODS
All the patients > or = 65 years hospitalized during the 4 week study period were included.


METHODS
During a first 2 week phase without intervention ADE's were recorded in all centres. Then units were then randomised for an educational intervention or not. The educational phase lasted 1 week, without ADE tracking. Then, both types of units (I+ and I-) recorded ADEs for 2 weeks. Possible drug-related incidents were detected using a standardized check list (nurses) and a weekly review of all charts by investigators. Possible drug-related incidents were analysed by a group of reviewers selected from the authors to classify them as ADE or not.


RESULTS
576 patients (mean age: 83.6 +/- 7.9 years) were consecutively included. The mean number of drugs at inclusion was 9.4 +/- 4.24 drugs per patient. 223 out of 755 events were considered "probable" ADEs (29.5%). Among the 223 ADEs, 62 (28%) could have been prevented. The main outcome of this trial was the change in the proportion of ADEs in elderly patients in the intervention-units, compared to the control group. The main errors were: to high a dose (26%), double therapy (21%), under dose (13%), inappropriate drug (13%), drug-drug interaction (6%), previous same adverse drug reaction (3%) and miscellaneous (11.18%). After a specific educational intervention program, there were fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004).


CONCLUSIONS
Educational programs could help reduce the prevalence of ADEs by 14% and encourage physicians to change outdated prescription habits.
Trivalle
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C
Pole Vieillissement, Readaptation et Accompagnement, Hopital Paul Brousse, (APHP), Villejuif, France. christophe.trivalle@pbr.aphp.fr
Cartier
T
T
Verny
C
C
Mathieu
A-M
AM
Davrinche
P
P
Agostini
H
H
Becquemont
L
L
Demolis
P
P
D016907:Adverse Drug Reaction Reporting Systems; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000517:prevention & control; D004347:Drug Interactions; D016903:Drug Monitoring; D062787:Drug Overdose / Q000517:prevention & control; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006266:Health Education; D006801:Humans; D007297:Inpatients / Q000193:education*; D008297:Male; D010353:Patient Education as Topic; D011446:Prospective Studies