Paper: Identification of Adverse Drug Events Post-Hospital Discharge in a Geriatric Population (2012 ACCP Annual Meeting)

Wednesday, October 24, 2012

Westin Diplomat Resort

Jennifer L. Donovan, PharmD¹, Abir O Kanaan, PharmD¹, Jennifer Tjia, MD, MSCE², Terry S. Field, DSc², Shawn Gagne, BS³, Lawrence Garber, MD⁴, Sarah L Cutrona, MD, MPH³, Leslie R Harrold, MD, MPH³, Peggy Preusse, RN, George Reed, PhD⁶ and Jerry H Gurwitz, MD³
1MCPHS University, Worcester, MA
2Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, MA
3Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
4Reliant Medical Group, Worcester, MA
5University of Massachusetts medical School, Worcester, MA

Purpose: Adverse drug events (ADEs), especially those that may be preventable, are among the most serious concerns regarding medication use in older persons. The purpose of this study was to describe the incidence, severity and preventability of ADEs occurring within 45 days post hospitalization in an ambulatory geriatric population.

Methods: We studied 1000 consecutive discharges of patients aged 65 and older who received medical care from a large multispecialty medical group in Central Massachusetts. Discharges were excluded if the discharge diagnosis was psychiatric or if discharges were not to home. Two trained clinical pharmacists reviewed the ambulatory records of each discharged patient to identify drug-related incidents occurring during the 45-day period post hospital discharge, which were subsequently presented to a pair of physician-reviewers who independently classified incidents as to whether an adverse drug event was present, the severity of the event, whether the event was preventable. When the physician-reviewers disagreed on the classification of an incident, they met and reached consensus; consensus was reached in all instances where there was initial disagreement.

Results: There were 244 ADEs identified, of which 34% (n=84) were considered preventable. Of the ADEs, 77% were categorized as less severe, 21% were serious, and 2% were life-threatening; of the serious and life-threatening events, 54% were considered preventable, compared to 21% of the less severe events. There was at least one ADE identified in 18.9% (n=189) of discharges during the 45-day period post hospitalization. There were 7.4% of discharges that had at least one ADE that was deemed preventable.

Conclusion: Adverse drug events are common and often preventable among older persons in the ambulatory setting. The substantial portion of serious events that were considered preventable suggests opportunities for improving care during the post-hospital discharge period.

184 Identification of Adverse Drug Events Post-Hospital Discharge in a Geriatric Population