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Adverse Drug Event (ADE)What is an Adverse Drug Event?
An adverse drug event isan injury resulting from the use of a drug
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Adverse Drug Event (ADE)Why pay attention to ADEs?Many people suffer injuries and even death from ADEs each year
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Most Common and Preventable ADEs in Outpatient CareKidney (e.g. abnormal levels of waste products, dehydration)GI: (abdominal pain, diarrhea, constipation)BleedingSugar/Diabetes
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Most Common and Preventable ADEs in in patients care
Neuropsychiatric: (oversedation, confusion, hallucinations and delirium)GI: (abdominal pain, diarrhea, constipation)BleedingKidney (e.g. abnormal levels of waste products, dehydration)
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What Mistakes Lead to High Rates of ADEs?
Prescribing (wrong dose, wrong drug)Transcription: transferring orders manually onto med sheet Dispensing Drug administrationMonitoring (poor response to signs of drug toxicity)
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Which Older Persons Are Most At Risk for ADEs?Persons taking more medications Persons taking drugs from several categoriesPersons taking: Anti-coagulants Anti-psychotics Antibiotics Seizure medications Diuretics
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Drug Use Among Older PersonsIn the community:
40% of those over 65 use 5 or more drugs per week
12% use 10 or more different medication
In patient care:
Average 6 8 drugs per resident
One-quarter (25%) of all residents use > 9 medications One-half (50%) are prn drugs
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Why So Many Meds?Older persons have multiple chronic medical conditionsMany conditions are treated with multiple drugsPhysicians feel pressured to prescribed
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Pharmacist Must Alert to the Five RightsRight PatientRight DrugRight DoseRight TimeRight Route
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How to avoid ADE Use best prescribing practicesBest drug or combination for conditionStart low and go slowAvoid drug-drug interactionsAvoid potential drug-disease interactionsMonitor drugs and patient reaction as neededProvide individualized medical care
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Verify the need for each drugRecord diagnosis for each drugRecord results of drug monitoringCollaborate with Quality Improvement efforts re medications.
How to avoid ADE
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Perform periodic drug reviewSafeguard against potential errorsWork as a member of the teamEducate team members
How to avoid ADE
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Communicate new complaints to caregivers and health care teamLearn about their current and new medicationsCheck medicines each time they are takenReport any side effects of medications How to avoid ADE
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