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Evaluation of adverse drug reactions in emergency department practice




De Andrés Lázaro AM, Sevilla Sánchez D, Ortega Romero M, Codina Jané C, Ribas Sala J, Sánchez Sánchez M



Servicio de Farmacia, Hospital Cl√≠nic, Barcelona, Spain. Servicio de Farmacia, Consorci Hospitalari de Vic, Barcelona, Spain. √Ārea de Urgencias, Hospital Cl√≠nic, Barcelona, Spain.



Objective: To assess the incidence of adverse drug reactions (ADRs) in the emergency
department of a tertiary care hospital, to determine the characteristics of the ADRs, to
identify related risk factors, and to evaluate medication errors associated with
preventable ADRs.
Methods: Descriptive observational study based on data extracted from medical
records. Patients admitted to hospital after attendance in the emergency department
over a 3-month period were included. ADRs were found following a previously
established method to identify ADR clues, or triggers, in patient records. The Karch-
Lasagna scale and the Hallas algorithm were used to evaluate causality, and the
Schumock-Thornton questionnaire was used to assess ADR preventability. All events that
were candidates for classification as ADRs were validated by 2 data collectors.
Results: In the records for the 237 patients included, 31 ADRs were detected (incidence,
13%). Most of the ADRs could be assigned a possible (61%) or probable (29%) cause.
Forty-five percent of the ADRs were caused by medication errors and could have been
prevented. The most common preventable ADRs were hypo- or hyperglycemia related to
antidiabetic medication. The most common errors involved failure to prescribe a
necessary medication (50%) or failure to administer one (21%). The most common
unavoidable ADRs were tachycardia and hyperglycemia related to salbutamol and
corticosteroids, respectively. The only factors associated with a higher prevalence of
ADRs were the number of drugs administered in the emergency department and
admission to the acute-care section of the department.
Conclusions: The incidence of ADRs in this study was high and preventable events were
detected. These findings are consistent with evaluations of ADRs in the hospital setting.


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