Outpatient Rx injuries are common in older patients

June 1, 2003

Pharmaceutical Representative

Medicare patients treated in the outpatient setting may suffer as many as 1.9 million drug-related injuries a year because of medical errors or adverse drug reactions not caused by errors.

Medicare patients treated in the outpatient setting may suffer as many as 1.9 million drug-related injuries a year because of medical errors or adverse drug reactions not caused by errors, according to a study published in the Journal of the American Medical Association (vol. 289, no. 9). The study, which was sponsored by the Rockville, MD-based Agency for Healthcare Research and Quality and the National Institute on Aging, found that about 180,000 of these injuries are life-threatening or fatal, and more than half are preventable. The estimates are based on a study of over 30,000 Medicare enrollees during 1999 and 2000.

"This is one of the first systematic examinations of the scope and causes of drug-related injuries to older patients in outpatient care," said Carolyn M. Clancy, director of the AHRQ. "The findings from this important study can help reduce their risks of drug-related injuries by providing information needed for the development and testing of prevention strategies using system-based approaches."

The researchers identified 1,523 drug-related injuries or "adverse drug events" in the population studied. Nearly 38% of the adverse drug events were characterized as serious, life-threatening or fatal. About 28% of the drug injuries overall were considered preventable by a panel of physician reviewers, as were 42% of the serious, life-threatening or fatal injuries.

Why adverse events occur

When the researchers analyzed why the preventable adverse drug events occurred, they found that 58% involved errors made when prescribing medications, such as ordering the wrong drug or dose, not educating the patient adequately about the medicine, or prescribing a medication for which there was a known interaction with another drug the patient was already taking. The investigators also found that 61% of preventable adverse drug events involved mistakes made in monitoring medications, such as inadequate laboratory monitoring or a delayed response to symptoms of drug toxicity in the patient. The failure of patients to adhere to medication instructions contributed to over 20% of the preventable drug-related injuries.

Preventing Rx injuries

Many adverse events could be prevented with the use of new technology, the authors of the study claim. "Computerized prescribing of medications in the office setting may provide the potential to prevent the prescribing of drugs with known interactions, or to warn the prescriber to intensify monitoring of the patient," said lead author Jerry H. Gurwitz. "Efforts to enhance patient knowledge about their medication regimens are also essential to reducing the risks of drug-related injuries." PR

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