A multicenter record review of in-hospital adverse drug events requiring a higher level of care.
OBJECTIVE
Adverse drug events (ADEs) are a worldwide concern, particularly when leading to a higher level of care. This study defines a higher level of care as an unplanned (re)admission to an intensive care unit or an intervention by a Medical Emergency Team. The objectives are to describe the incidence and preventability of ADEs leading to a higher level of care, to assess the types of drug involved, and to identify the risk factors.


METHODS
A three-stage retrospective review was performed in six Belgian hospitals. Patient records were assessed by a trained clinical team consisting of a nurse, a physician, and a clinical pharmacist. Descriptive statistics, univariate, and multiple logistic regressions were used.


RESULTS
In this study, 830 patients were detected for whom a higher level of care had been needed. In 160 (19.3%) cases, an ADE had occurred; 134 (83.8%) of these were categorized as preventable adverse drug events (pADEs). The overall incidence rate of patients transferred to a higher level of care because of a pADE was 33.9 (95% CI: 28.5-39.3) per 100,000 patient days at risk. Antibiotics and antithrombotic agents accounted both for one-fifth of all pADEs. Multivariate analysis indicated American Society of Anaesthesiologists physical status score as a risk factor for pADEs.


CONCLUSIONS
The high number of pADE with patient harm shows that there is a need for structural improvement of pharmacotherapeutic care. Detection of these pADEs can be the basis for the implementation of these improvements.
a Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.|b Jessa Hospital , Hasselt , Belgium.
Kristel
K
Marquet
a Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.|c Health Care Management , Antwerp Management School , Antwerp , Belgium.
Neree
N
Claes
a Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.|b Jessa Hospital , Hasselt , Belgium.
Elke
E
De Troy
a Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.
Gaby
G
Kox
a Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.|b Jessa Hospital , Hasselt , Belgium.
Martijn
M
Droogmans
a Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.|d Centre for Health Services and Nursing Research , Catholic University Leuven , Leuven , Belgium.
Arthur
A
Vleugels
D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies
Adverse drug events; Adverse drug reaction; Drug safety; Intensive care unit; Preventable adverse drug event; Record review