Vancouver Sun
Side effects lead to ER visits
Twelve per cent of patients rushed to VGH have adverse reaction to medications, study finds
Pamela Fayerman, Vancouver Sun
Published: Tuesday, June 03, 2008
VANCOUVER - Twelve per cent of patients who rush to the emergency room at Vancouver General Hospital are there because of adverse effects from medications, according to study findings being published Tuesday in the Canadian Medical Association Journal.
The 11 international authors of the study said patients with medication-related complaints are more likely to be admitted to hospital beds after they've been seen in the ER and occupy those beds far longer than others, a result the authors described as "striking."
The study estimates that 70 per cent of such visits are preventable through better prescribing, dispensing and monitoring of patients.
"We've proven in this study that we've got a problem in the health care system with patients who experience bad effects from medications and we have to figure out how to reduce those problems," said lead investigator Dr. Peter Zed, who was working at VGH during the study but is now at the Queen Elizabeth Health Sciences Centre in Halifax.
"The solutions will involve better communication among doctors, pharmacists and patients," Zed said in an interview. "Simply handing out a pamphlet at the pharmacy that lists all the potential side-effects doesn't work. Patients don't read them or they don't understand the information."
Problems stemmed from a variety of issues including patients being prescribed the wrong drugs, given wrong dosages, allergic reactions, interactions between drugs and patients not following instructions for how or when to take their medications.
A future study will help determine the best approaches to avoid such problems, Zed said, but plans by the B.C. government to broaden the use of electronic health records will help reduce medication errors. The new record-keeping system will improve communication among doctors, pharmacists and other health providers as well as provide information about the best drugs to prescribe, drug interactions and proper dosages.
About 180 patients a day go to the ER at VGH, B.C.'s biggest hospital with 955 beds. Slightly more than 1,000 patients were randomly selected during a 12-week period from March to June, 2006. In that period, a total of nearly 15,000 patients went to the ER.
Of the 1,017 patients included in the study, 122 - or just over one in nine patients - were at the hospital because of adverse drug-related events, defined as "unfavourable occurrences related to the use or misuse of medications."
No one died from medication effects, but those who were admitted to hospital stayed a median of eight days, compared to 5.5 days for those who were admitted with non-medication problems.
Health Minister George Abbott said in an interview the study points to the need for "continuous improvement when it comes to misuse, overuse and abuse of drugs."
The province plans to establish a patient safety and quality council to reduce adverse events, promote transparency and identify best practices to improve patient care, Abbott said.
A total of 179 medications were implicated in the 122 drug-related visits to ER. Nearly 16 per cent of cases were mild (no treatment required), 75 per cent were moderate (treatment and/or hospital admission required) and just under 10 per cent were severe, with life-threatening symptoms potentially resulting in permanent disability.
The mean age of patients in both arms of the study (drug-related complaints and non-drug) was about 50 and gender was also about evenly split.
Adverse drug reactions are often tricky to sort out, and the authors said that is why many patients have to be admitted to hospital beds for monitoring and resolution of their concerns.
Central nervous system medications such as opioid painkillers, antipsychotics for those with mental health issues, sleeping pills, and antidepressants were the types of drugs most likely to cause problems.
Cardiovascular drugs were next and then antimicrobial drugs for infections. The study found that more than two-thirds of patients with medication problems could have avoided their ER visits with better prescribing and better comprehension of how to take the drugs.
Patients in the study were interviewed to determine their primary complaints and to get their health and medication history, and allergy status. A month after they were discharged from hospital they were called by researchers about their progress and outcomes.
Sun Health Issues Reporter
pfayerman@png.canwest.com
http://www.canada.com/vancouversun/news/story.html?id=5481d91d-47c1-4b7a-bb3e-87aa888ad49f
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