Medication safety is an important component of the medication use process and includes preventing adverse drug events (ADE). Identification of drugs leading to adverse drug events, emergency department (ED) visits and hospitalizations is important for all healthcare providers, and especially pharmacists, to help target programs to promote safe use of the medications through various strategies. A high-risk group of patients for ADE are individuals older than 65 years who are also the largest consumers of medications.1 Of men and women aged 65 years and older, 57 to 59% report use of five or more prescription medications.1 Previous studies have found that individuals 65 years and older are 2.4-times more likely to sustain an ADE and 6.8-times more likely to be hospitalized for an ADE than younger individuals.2
To specifically evaluate hospitalizations for ADE in older individuals (65 years and older), Bodnitz and colleagues reviewed adverse-event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project from 2007 to 2009.3 Trained coders reviewed medical records of ED visits to identify cases resulting in hospitalization due to the use of a drug or a drug-specific adverse effect. The primary outcome was hospitalization after an ED visit for an ADE due to medications. A secondary outcome was hospitalization after an ED visit for an ADE due to a “high-risk” medication for the elderly (HEDIS 2011) or a “potentially inappropriate” (Beers criteria) medication.3
The study found in elderly individuals an estimated 265,802 ED visits for ADE occurred yearly between 2007 and 2009. Hospitalization resulted in 37.5% of the ED visits, and 48.1% of the hospitalizations were in adults 80 years and older. ED visits resulting in hospitalization were more likely to involve unintentional overdose (65.7%) and five or more concurrent medications (54.8%). Four of the most commonly implicated medications resulting in hospitalization were warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%) and oral hypoglycemic agents (10.7%); combined, the four medications resulted in two-thirds of the hospitalizations. Warfarin and antiplatelet agents mainly resulted in hemorrhagic events, and insulins and oral hypoglycemic events most commonly resulted in hypoglycemia. Only 1.2% of hospitalizations due to ADE were due to HEDIS high-risk medications and 6.6% due to Beer-criteria potentially inappropriate medications.3
The authors concluded that most emergency hospitalizations in adults 65 years and older for ADE result from a few common medications, and a minority of hospitalizations resulted from medications designated as high-risk for the elderly. Limitations of the study include the surveillance system and reporting mechanisms, the retrospective nature of the study, and underreporting of hospitalizations for ADE that were not admitted through the ED. The findings illustrate the importance of improving how high risk medications are used, such as warfarin, antiplatelet agents, insulin and oral hypoglycemic agents. Studies have shown the benefits of pharmacist services in improving clinical and adverse outcomes with these medications through pharmacist services in anticoagulation and diabetes management.4,5 More widespread use of these services ...