title: Risk of medication safety incidents with antibiotic use measured by defined daily doses.
abstract: BACKGROUND
  Medication incidents (MIs) account for 11.3 % of all reported patient-safety incidents in England and Wales. Approximately one-third of inpatients are prescribed an antibiotic at some point during their hospital stay. The WHO has identified incident reporting as one solution to reduce the recurrence of adverse incidents.
  
  
  OBJECTIVE
  The aim of this study was to determine the number and nature of reported antibiotic-associated MIs occurring in inpatients and to use defined daily doses (DDDs) to calculate the incident rate for the antibiotics most commonly associated with MIs at each hospital.
  
  
  METHODS
  Two UK acute NHS teaching hospitals.
  
  
  METHODS
  Retrospective quantitative analysis was performed on antibiotic-associated MIs reported to the risk management system over a 2-year period. Quality-assurance measures were undertaken before analysis. The study was approved by the clinical audit departments at both hospitals. Drug consumption data from each hospital were used to calculate the DDD for each antibiotic.
  
  
  METHODS
  The number of antibiotic-related MIs reported and the incident rate for the 10 antibiotics most commonly associated with MIs at each hospital.
  
  
  RESULTS
  Healthcare staff submitted 6,756 reports, of which 885 (13.1 %) included antibiotics. This resulted in a total of 959 MIs. Most MIs occurred during prescribing (42.4 %, n = 407) and administration (40.0 %, n = 384) stages. Most common types of MIs were omission/delay (26.3 %, n = 252), and dose/frequency (17.9 %, n = 172). Penicillins (34.5 %, n = 331) and aminoglycosides (16.6 %, n = 159) were the most frequently reported groups with co-amoxiclav (16.8 %, n = 161) and gentamicin (14.1 %, n = 135) the most frequently reported drugs. Using DDDs to assess the incident rate showed that cefotaxime (105.4/10,000 DDDs), gentamicin (25.7/10,000 DDDs) and vancomycin (23.7/10,000 DDDs) had the highest rates.
  
  
  CONCLUSIONS
  This study highlights that detailed analysis of data from reports is essential in understanding MIs and developing strategies to prevent their recurrence. Using DDDs in the analysis of MIs allowed determination of an incident rate providing more useful information than the absolute numbers alone. It also highlighted the disproportionate risk associated with less commonly prescribed antibiotics not identified using MI reporting rates alone.
authors.affiliation: King's College London, King's Health Partners, Pharmaceutical Science Clinical Academic Group, Institute of Pharmaceutical Science, Franklin-Wilkins Building, 150 Stamford St, London, SE1 9NH, UK, anas.hamad@kcl.ac.uk.
authors.forename: Anas
authors.initials: A
authors.lastname: Hamad
authors.forename: Gillian
authors.initials: G
authors.lastname: Cavell
authors.forename: Paul
authors.initials: P
authors.lastname: Wade
authors.forename: James
authors.initials: J
authors.lastname: Hinton
authors.forename: Cate
authors.initials: C
authors.lastname: Whittlesea
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D054869:Clinical Audit; D016903:Drug Monitoring; D004739:England / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D020407:Internet; D019300:Medical Errors / Q000009:adverse effects / Q000517:prevention & control; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control*; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012306:Risk; D012308:Risk Management; D012720:Severity of Illness Index; D013222:State Medicine; D035141:Voluntary Programs; D014852:Wales / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents