Skip to main content
Log in

Defining and classifying terminology for medication harm: a call for consensus

  • Review
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The multiplicity in terms and definitions of medication-related harm has been a long-standing challenge for health researchers, clinicians, and regulatory bodies. The purpose of this narrative review was to report the diversity of terms; compare definitions, classifications, and models describing medication harm; and suggest which may be useful in both clinical practice and the research setting.

Methods

A narrative review of key studies defining and/or classifying medication harm terminology was undertaken.

Results

This review found that numerous terms are used to describe medication harm, and that there is a lack of consistency in current definitions, classifications, and applications. This lack of consistency applied across clinical jurisdictions and regulatory terminologies. A number of limitations in current definitions and classifications were identified. These included the exclusion of key types of medication harm events, ambiguous wording, and a lack of clarity and consensus on subclassifications. In general, there was some overlap in key models from the literature and these were presented to describe similarities and differences.

Conclusion

Without uniformity quantifying, comparing, combining, or extrapolating medication harm data, such as a rate of harm in a specific population, is a challenge for those involved in medication safety and pharmacovigilance. There is a pressing need for further discussion and international consensus on this topic. Adoption of standard descriptors by practitioner groups, regulatory and policy organisations would foster quality improvement and patient safety.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Agency for Healthcare Research and Quality. Medication Errors 2017. Available from: https://psnet.ahrq.gov/primers/primer/23/medication-errors

  2. Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M (2009) Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One 4(2):e4439

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279:1200–1205

    Article  CAS  PubMed  Google Scholar 

  4. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ et al (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. BMJ 329(3)

  5. Budnitz DS, Lovegrove MC, Shehab N, Richards CL (2011) Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 365(21):2002–2012

    Article  CAS  PubMed  Google Scholar 

  6. Trivalle C, Burlaud A, Ducimetière P (2011) Risk factors for adverse drug events in hospitalized elderly patients: a geriatric score. European Geriatric Medicine 2(5):284–289

    Article  Google Scholar 

  7. Falconer N, Barras MA, Cottrell WN (2018) Systematic review of predictive risk models for adverse drug events in hospitalised patients. Br J Clin Pharmacol 84(5):846–864

    Article  PubMed  PubMed Central  Google Scholar 

  8. World Health Organisation. Glossary of Patient Safety Concepts and References 2009

  9. Edwards IR, Aronson JK (2000) Adverse drug reactions: definitions, diagnosis and management. Lancet 356(9237):1255–1259

    Article  CAS  PubMed  Google Scholar 

  10. Ackroyd-Stolarz S, Hartnell N, McKinnon NJ (2006) Demystifying medication safety: making sense of the terminology. Res Soc Adm Pharm 2:280–289

    Article  Google Scholar 

  11. Yu KH, Nation RL, Dooley MJ (2005) Multiplicity of medication safety terms, definitions and functional meanings: when is enough enough? Qual Saf Health Care 14:358–363

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lisby M, Nielsen LP, Brock B, Mainz J (2010) How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care 22:507–518

    Article  CAS  PubMed  Google Scholar 

  13. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD (1990) Drug-related problems: their structure and function. Drug Intell Clin Pharm 24:1093–1097

    CAS  Google Scholar 

  14. Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L (1995b) Relationship between medication errors and adverse drug events. J Gen Intern Med 10:199–205

    Article  CAS  PubMed  Google Scholar 

  15. American Society of Health-System Pharmacists (1998) Suggested definitions and relationships among medication misadventures, medication errors, adverse drug events and adverse drug reactions. Am J Health Syst Pharm 55:165–166

    Article  Google Scholar 

  16. Rawlins M, Thompson JW (1977) Pathogenesis of adverse drug reactions: textbook of adverse drug reactions. Oxford University Press, Oxford

    Google Scholar 

  17. Meyboom RH, Lindquist M, Egberts AC (2000) An ABC of drug-related problems. Drug Saf 22(6):415–423

    Article  CAS  PubMed  Google Scholar 

  18. Nebeker JR, Barach P, Samore MH (2004) Clarifying adverse drug events: a clinician’s guide to terminology, documentation and reporting. Ann Intern Med 140:795–801

    Article  PubMed  Google Scholar 

  19. Morimoto T, Gandhi TK, Seger AC, Hsieh TC, Bates DW (2004) Adverse drug events and medication errors: detection and classification methods. Qual Saf Health Care. 13(4):306–314

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. National Coordinating Centre for Medication Error Reporting and Prevention (NCC MERP). Taxonomy for Medication Errors 2005 [cited 2018 5 Jan]. Available from: http://www.nccmerp.org/taxonomy-medication-errors-now-available

  21. Otero López MJ, Dominguez-Gil A (2000) Adverse drug events: an emerging pathology. Pharm Hosp 24(4):258–266

    Google Scholar 

  22. Otero MJ, Schmitt E (2005) Comments and responses: Clarifying terminology for adverse drug events. Ann Intern Med 142:77

    Article  PubMed  Google Scholar 

  23. Aronson JK, Ferner RE (2005) Classification of terminology in drug safety. Drug Saf 28(10):851–870

    Article  PubMed  Google Scholar 

  24. The PCNE Classification V 7.0 [Internet]. Pharmaceutical Care Network Europe Foundation. 2016 [cited 19th March 2017]. Available from: http://www.pcne.org/working-groups/2/drug-related-problems

  25. Bürkle T, Müller F, Patapovas A, Sonst A, Pfistermeister B, Plank-Kiegele B, Dormann H, Maas R (2013) A new approach to identify, classify and count drug-related events. Br J Clin Pharmacol 76:56–58

    Article  PubMed  PubMed Central  Google Scholar 

  26. Canadian Patient Safety Institute. The Economics of Patient Safety in Acute Care - Technical Report 2018. Available from: http://www.patientsafetyinstitute.ca/en/search/pages/results.aspx?k=adverse%20drug%20events

  27. European Medicines Agency. Question and answer document on the European database of adverse drug reaction reports website London2012. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Other/2012/05/WC500127958.pdf

  28. International Conference on Harmonisation (ICH). Post-Approval Safety Data Management: Definitions and Standards for Expedited Reporting 2003. Available from: http://www.ich.org/home.html

  29. Institute For Healthcare Improvement (IHI). Adverse Drug Events per 1000 2018. Available from: http://www.ihi.org/resources/Pages/Measures/ADEsper1000Doses.aspx

  30. Institute for Safe Medication Practices. ISMP Medication Safety Alert! Adverse drug reactions: documentation is important but communication is critical Horsham, PA.2018. Available from: http://www.ismp.org/Newsletters/acutecare/articles/20000906.asp

  31. Therapeutic Goods Administration. Reporting adverse drug reactions 2014. Available from: https://www.tga.gov.au/publication/reporting-adverse-drug-reactions#whattoreport

  32. Aronson JK (2009) Medication errors: definitions and classification. Br J Clin Pharmacol 67(6):599–603

    Article  PubMed  PubMed Central  Google Scholar 

  33. The use of the WHO-UMC system for standardised case causality assessment [Internet]. Uppsala Monitoring Centre. [cited 2 Jan 2018]. Available from: http://www.who.int/medicines/areas/quality_safety/safety_efficacy/WHOcausality_assessment.pdf

  34. Naranjo CA, Busto U, SE M, Sandor P, Ruiz I (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245

    Article  CAS  PubMed  Google Scholar 

  35. Hallas J, Harvald B, Gram LF, GRODUM E, BROSEN K, HAGHFELT T et al (1990) Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med 228(2):83–90

    Article  CAS  PubMed  Google Scholar 

  36. Bates DW, Cullen DJ, Laird N, Peterson LA, Small SD, Servi D et al (1995a) Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 274:29–34

    Article  CAS  PubMed  Google Scholar 

  37. Aronson JK, Ferner RE (2003) Joining the DoTS: new approach to classifying adverse drug reactions. BMJ 327(7425):1222–1225

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991) The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324(6):377–384

    Article  CAS  PubMed  Google Scholar 

  39. Kohn LT, Corrigan JM, Donaldson MS (1999) To err is human - building a safer health system. National Academy Press, Washington, DC

    Google Scholar 

  40. International Conference on Harmonisation (ICH). Medical Dictionary for Regulatory Activities MedDRA - version 20.0 2017. Available from: https://www.meddra.org/how-to-use/support-documentation?current

  41. Aronson JK, Ferner RE (2010) Preventability of drug-related harms — part II. Drug Saf 33(11):995–1002

    Article  PubMed  Google Scholar 

  42. Hepler CD, Strand LM (1990) Oppurtunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 47:533–543

    CAS  PubMed  Google Scholar 

  43. Mirbaha F, Shalviri G, Yazdizadeh B, Gholami K, Majdzadeh R (2015) Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Implement Sci 10:110

    Article  PubMed  PubMed Central  Google Scholar 

  44. Evans SM, Berry JG, Smith BJ, Esterman A, Selim P, O’Shaughnessy J, DeWit M (2006) Attitudes and barriers to incident reporting: a collaborative hospital study. Qual Saf Health Care 15(1):39–43

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Walter SR, Day RO, Gallego B, Westbrook JI (2017) The impact of serious adverse drug reactions: a population-based study of a decade of hospital admissions in New South Wales, Australia. Br J Clin Pharmacol 83:416–426

    Article  CAS  PubMed  Google Scholar 

  46. Hohl C, Karpov A, Reddekopp L, Stausberg J (2014) ICD-10 codes used to identify adverse drug events in administrative data: a systematic review. J Am Med Inform Assoc 21:547–557

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nazanin Falconer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Key points

• Multiple terms and definitions are used to describe medication harm in research and clinical practice.

• The lack of consistency makes it challenging to quantify the true burden of medication-harm, or to make meaningful extrapolations from harm data.

• There is a pressing need for adoption of standard terms and definitions for medication harm.

Electronic supplementary material

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Falconer, N., Barras, M., Martin, J. et al. Defining and classifying terminology for medication harm: a call for consensus. Eur J Clin Pharmacol 75, 137–145 (2019). https://doi.org/10.1007/s00228-018-2567-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-018-2567-5

Keywords

Navigation