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Drug Safety

, Volume 30, Issue 5, pp 379–407 | Cite as

Drug-Related Problems in Hospitals

A Review of the Recent Literature
  • Anita Krähenbühl-Melcher
  • Raymond Schlienger
  • Markus Lampert
  • Manuel Haschke
  • Jürgen Drewe
  • Stephan Krähenbühl
Review Article

Abstract

Problems associated with pharmacotherapy (in particular, medication errors and adverse drug events) are frequent and are associated with increased costs for treatment.

Analysis of original publications published between 1990 and 2005 on the topics of medication errors and/or adverse drug events in hospitalised patients, focusing on the frequency of, risk factors for and avoidance of such problems associated with pharmacotherapy, indicated that medication errors occurred in a mean of 5.7% of all episodes of drug administration, but with a high variability among the 35 studies retrieved. This variability was explained by the methods by which medication errors were detected (systematic screening of patients versus chart review or spontaneous reporting) and by the way drugs were administered (intravenously administered drugs are associated with the highest error frequencies). Errors occurred throughout the whole medication process, with administration errors accounting for more than half of all errors. Important risk factors included insufficient pharmacological knowledge of health professionals, errors in the patient charts or documentation by nurses and inadequate pharmacy services.

Adverse events or reactions, on the other hand, affected 6.1 patients per 100 hospitalised and also showed a high variability among the 46 studies retrieved. This variability could also be explained by the different methods of assessment of the frequency of adverse drug events or reactions, as well as by the different wards on which the studies were performed. Important risk factors for adverse drug events or reactions included polypharmacy, female sex, drugs with a narrow therapeutic range, renal elimination of drugs, age >65 years and use of anticoagulants or diuretics.

Since medication errors are strong risk factors for preventable adverse drug events or reactions, strategies have to be put in place for their reduction. Such strategies include ensuring that all persons involved in the medication process (nurses, pharmacists and physicians) have good pharmacological knowledge, computerisation of the entire medication process, and the engagement of a sufficient number of clinical pharmacists on the wards.

Keywords

Adverse Drug Reaction Medication Error Adverse Drug Event Clinical Pharmacist Computerise Physician Order Entry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work was supported by a grant from the Swiss National Science Foundation to S.K. (310000-112483/1). The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Anita Krähenbühl-Melcher
    • 1
  • Raymond Schlienger
    • 2
  • Markus Lampert
    • 2
  • Manuel Haschke
    • 2
  • Jürgen Drewe
    • 2
  • Stephan Krähenbühl
    • 2
  1. 1.Hospital PharmacyRegionalspital EmmentalBurgdorfSwitzerland
  2. 2.Division of Clinical Pharmacology and ToxicologyUniversity HospitalBaselSwitzerland

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