Adverse Drug Event (ADE)What is an Adverse Drug Event?

An adverse drug event isan injury resulting from the use of a drug

Adverse Drug Event (ADE)Why pay attention to ADEs?Many people suffer injuries and even death from ADEs each year

Most Common and Preventable ADEs in Outpatient CareKidney (e.g. abnormal levels of waste products, dehydration)GI: (abdominal pain, diarrhea, constipation)BleedingSugar/Diabetes

Most Common and Preventable ADEs in in patients care

Neuropsychiatric: (oversedation, confusion, hallucinations and delirium)GI: (abdominal pain, diarrhea, constipation)BleedingKidney (e.g. abnormal levels of waste products, dehydration)

What Mistakes Lead to High Rates of ADEs?

Prescribing (wrong dose, wrong drug)Transcription: transferring orders manually onto med sheet Dispensing Drug administrationMonitoring (poor response to signs of drug toxicity)

Which Older Persons Are Most At Risk for ADEs?Persons taking more medications Persons taking drugs from several categoriesPersons taking: Anti-coagulants Anti-psychotics Antibiotics Seizure medications Diuretics

Drug Use Among Older PersonsIn the community:

40% of those over 65 use 5 or more drugs per week

12% use 10 or more different medication

In patient care:

Average 6 8 drugs per resident

One-quarter (25%) of all residents use > 9 medications One-half (50%) are prn drugs

Why So Many Meds?Older persons have multiple chronic medical conditionsMany conditions are treated with multiple drugsPhysicians feel pressured to prescribed

Pharmacist Must Alert to the Five RightsRight PatientRight DrugRight DoseRight TimeRight Route

How to avoid ADE Use best prescribing practicesBest drug or combination for conditionStart low and go slowAvoid drug-drug interactionsAvoid potential drug-disease interactionsMonitor drugs and patient reaction as neededProvide individualized medical care

Verify the need for each drugRecord diagnosis for each drugRecord results of drug monitoringCollaborate with Quality Improvement efforts re medications.

How to avoid ADE

Perform periodic drug reviewSafeguard against potential errorsWork as a member of the teamEducate team members

How to avoid ADE

Communicate new complaints to caregivers and health care teamLearn about their current and new medicationsCheck medicines each time they are takenReport any side effects of medications How to avoid ADE

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