Abstract
Background/Aims 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. Three clinical pharmacist investigators reviewed the ambulatory records of each discharged patient to identify drug-related incidents occurring during the 45-day period post hospital discharge. Drug-related incidents were 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, and 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 242 ADEs identified, of which 35% (n = 84) were considered preventable. Of the preventable ADEs, 63% (n = 53) were categorized as significant, 32% (n = 27) were serious, and 5% (n = 4) were life-threatening. Nearly half of all ADEs occurred within the first two weeks following discharge.
Conclusions 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.
