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Observational Study
. 2019 Aug 8;19(1):555.
doi: 10.1186/s12913-019-4381-x.

Improving drug safety in hospitals: a retrospective study on the potential of adverse drug events coded in routine data

Nils Kuklik  1   2 , Jürgen Stausberg  3 , Marjan Amiri  4 , Karl-Heinz Jöckel  3
Affiliations
Observational Study

Improving drug safety in hospitals: a retrospective study on the potential of adverse drug events coded in routine data

Nils Kuklik et al. BMC Health Serv Res. .

Abstract

Background: Adverse drug events (ADEs) that occur during hospitalization are an ongoing medical concern. Systematic strategies for ADE identification are lacking. The aim of this study was to evaluate the potential to identify adverse drug events caused by medication errors (preventable ADEs, pADEs), and previously unknown adverse drug reactions (ADRs or non-preventable ADEs, npADEs) in inpatients by combining diagnosis codes in routine data with a chart review.

Methods: Diagnoses of inpatients are routinely coded using the International Classification of Diseases, 10th Revision (ICD-10). A total of 2326 cases were sampled from routine data of four hospitals using a set of ICD-10 German Modification ADE codes. Following a chart review, cases were evaluated in a standardized process with regard to drug relation and preventability of events.

Results: By chart review, 1302 cases were classified as hospital-acquired and included in the evaluation. This yielded 1285 cases indicating an ADE. 96.8% of ADEs (1244 ADEs) were classified as known npADEs, only three cases as suspected previously unknown npADEs, one case as event after drug abuse. A total of 37 ADEs were classified as preventable (2.9% of all ADEs) by identifying a medication error as probable cause. The prevalence of pADEs varied considerably between included ADE codes, with hemorrhagic diathesis due to coumarins and localized skin eruptions showing the highest rates (8.7 and 9.1%, respectively). Most frequent medication errors were non-compliance to a known allergy, and improper dose.

Conclusions: When focusing on specific ADE codes, routine data can be used as markers for npADEs and medication errors, thus providing a meaningful complement to existing drug surveillance systems. However, the prevalence of medication errors is lower than in former studies on the frequency of pADEs.

Keywords: Adverse drug event; Drug safety; ICD-10; Medication error; Routine data.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic representation of the review and evaluation process. ADE = adverse drug event; npADE = non-preventable adverse drug event; pADE = preventable adverse drug event
See this image and copyright information in PMC

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