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Adverse Drug Events Resulting from Patient Errors in Older Adults
Author(s) -
Field Terry S.,
Mazor Kathleen M.,
Briesacher Becky,
DeBellis Kristin R.,
Gurwitz Jerry H.
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01047.x
Subject(s) - medicine , confidence interval , odds ratio , comorbidity , adverse effect , polypharmacy , emergency medicine , cohort , regimen , cohort study , pediatrics
OBJECTIVES: To characterize the types of patient‐related errors that lead to adverse drug events (ADEs) and identify patients at high risk of such errors. DESIGN: A subanalysis within a cohort study of Medicare enrollees. SETTING: A large multispecialty group practice. PARTICIPANTS: Thirty thousand Medicare enrollees followed over a 12‐month period. MEASUREMENTS: Primary outcomes were ADEs, defined as injuries due to a medication, and potential ADEs, defined as medication errors with the potential to cause an injury. The subset of these events that were related to patient errors was identified. RESULTS: The majority of patient errors leading to adverse events (n=129) occurred in administering the medication (31.8%), modifying the medication regimen (41.9%), or not following clinical advice about medication use (21.7%). Patient‐related errors most often involved hypoglycemic medications (28.7%), cardiovascular medications (21.7%), anticoagulants (18.6%), or diuretics (10.1%). Patients with medication errors did not differ from a comparison group in age or sex but were taking more regularly scheduled medications (compared with 0–2 medications, odds ratio (OR) for 3–4 medications=2.0, 95% confidence interval (CI)=0.9–4.2; OR for 5–6 medications=3.1, 95% CI=1.5–7.0; OR for ≥7 medications=3.3, 95% CI=1.5–7.0). The strongest association was with the Charlson Comorbidity Index (compared with a score of 0, OR for a score of 1–2=3.8, 95% CI=2.1–7.0; OR for a score of 3–4=8.6, 95% CI=4.3–17.0; OR for a score of ≥5=15.0, 95% CI=6.5–34.5). CONCLUSION: The medication regimens of older adults present a range of difficulties with the potential for harm. Strategies are needed that specifically address the management of complex drug regimens.