Preventable adverse drug reactions

Adverse drug events (ADE) are common in emergency departments and acute care hospitals but are poorly documented in electronic medical records and administrative data. This increases the likelihood of recurrence due to lack of information continuity between providers and across health sectors. The objective of this query is to determine the preventability of an ADE, identify contributing factors, determine the ADE-related harm and interventions required, and identify the kind of drug re-exposure that would likely cause a future repeat ADE.

In Phase 1 of the query, a retrospective chart review of 1,234 patients found 1,356 ADEs with the majority being from adverse drug reactions and non-adherence. 64%of ADEs were determined to be preventable and 29% were repeat events. Certain drugs, inadequate patient counselling, lack of follow-up after a change in the regimen, mental health diagnoses, diabetes, and a prior ADE to the same drug were associated with patients having preventable ADEs. Diabetes and renal failure were significant in association with patients having repeat ADEs.

In Phase 2, phase I data was linked to BC health data (PharmaNet) to determine the proportion of ADE patients that were re-exposed to contraindicated medications. 

Future work will involve survival analysis regression to examine risk factors for the hazard of re-exposure by modeling the time-to-re-dispensation

Woo SA, Cragg A, Wickham ME, Peddie D, Balka E, Scheuermeyer F, Villanyi D, Hohl CM. Methods for evaluating adverse drug event preventability in emergency department patients. BMC Red Res Methodol. 2018;18:160.

Hohl CM, Woo SA, Cragg A, Wickham ME, Ackerley C, Scheuermeyer F, Villanyi D. Repeat adverse drug events associated with outpatient medications: a descriptive analysis of 3 observational studies in British Columbia, Canada. CMAJ Open. July 2019;7(3):E446-53.

Woo SA, Cragg A, Wickham ME, Villanyi D, Scheuermeyer F, Hau JP, Hohl C. Preventable adverse drug events: Descriptive epidemiology. Br J Clin Pharmacol. 2020 Feb;86(2):291-302. 

Hohl et al. Repeat exposures to culprit drugs contribute to adverse drug events in emergency department patients. 2017 (CAEP abstract).

Hohl et al. Preventable adverse drug events in Canadian emergency departments. 2017 (CAEP abstract).

Woo et al. Factors contributing to the development of adverse drug events treated in emergency departments. 2017 (CAEP abstract).

Wickham et al. Preventable and repeat adverse drug events in Canadian emergency department patients. 2017 (CAHSPR abstract).

Woo et al. Preventable adverse drug events in Canadian emergency departments. 2019 (CAEP abstract).

For more information, contact: Autumn Neville, Research Coordinator. autumn.neville@rimuhc.ca

This research is funded by CIHR-DSEN 
Lead investigator: Dr. Corinne Hohl
Query 16-03 raised by Health Canada