Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients

Abstract Objective To ascertain the current burden of adverse drug reactions (ADRs) through a prospective analysis of all admissions to hospital. Design Prospective observational study. Setting Two large general hospitals in Merseyside, England. Participants 18 820 patients aged > 16 years admitted over six months and assessed for cause of admission. Main outcome measures Prevalence of admissions due to an ADR, length of stay, avoidability, and outcome. Results There were 1225 admissions related to an ADR, giving a prevalence of 6.5%, with the ADR directly leading to the admission in 80% of cases. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. The projected annual cost of such admissions to the NHS is £466m (€706m, $847m). The overall fatality was 0.15%. Most reactions were either definitely or possibly avoidable. Drugs most commonly implicated in causing these admissions included low dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs other than aspirin, the most common reaction being gastrointestinal bleeding. Conclusion The burden of ADRs on the NHS is high, accounting for considerable morbidity, mortality, and extra costs. Although many of the implicated drugs have proved benefit, measures need to be put into place to reduce the burden of ADRs and thereby further improve the benefit:harm ratio of the drugs.

[1]  A. H. Knight,et al.  Admissions to hospital due to drugs. , 1969, British medical journal.

[2]  N Hurwitz,et al.  Intensive Hospital Monitoring of Adverse Reactions to Drugs , 1969, British medical journal.

[3]  N Hurwitz,et al.  Predisposing Factors in Adverse Reactions to Drugs , 1969, British medical journal.

[4]  J. Mckenney,et al.  Drug-related hospital admissions. , 1976, American journal of hospital pharmacy.

[5]  D. Davies,et al.  Textbook of Adverse Drug Reactions , 1992, Annals of Internal Medicine.

[6]  J. Williamson,et al.  Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. , 1980, Age and ageing.

[7]  Karabi Ghose.  Hospital Bed Occupancy due to Drug-Related Problems1 , 1980, Journal of the Royal Society of Medicine.

[8]  D. Greenblatt,et al.  A method for estimating the probability of adverse drug reactions , 1981, Clinical pharmacology and therapeutics.

[9]  J. Jones.  Adverse drug reactions in the community health setting: approaches to recognizing, counseling, and reporting. , 1982, Family & community health.

[10]  R. Tallis,et al.  PRESCRIPTION OF CONTRAINDICATED AND INTERACTING DRUGS IN ELDERLY PATIENTS ADMITTED TO HOSPITAL , 1984, The Lancet.

[11]  S. Roy,et al.  Adverse drug reactions: an investigation on an acute geriatric ward. , 1986, Age and ageing.

[12]  J. Hallas,et al.  Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention , 1990, Journal of internal medicine.

[13]  R. Tallis,et al.  Inappropriate medication is a major cause of adverse drug reactions in elderly patients. , 1992, Age and ageing.

[14]  A. B. Prasad,et al.  British National Formulary , 1994 .

[15]  M. Rawlins,et al.  Prophylactic aspirin and risk of peptic ulcer bleeding , 1995, BMJ.

[16]  J. Aronson,et al.  Adverse drug reactions in a hospital general medical unit meriting notification to the Committee on Safety of Medicines. , 1996, British journal of clinical pharmacology.

[17]  David W. Bates,et al.  The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group , 1997 .

[18]  D. Bates,et al.  The Costs of Adverse Drug Events in Hospitalized Patients , 1997 .

[19]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[20]  J. Buechner.  Adverse drug reactions in hospital patients. , 1998, Medicine and health, Rhode Island.

[21]  P. Corey,et al.  Incidence of Adverse Drug Reactions in Hospitalized Patients , 2012 .

[22]  A. Egberts,et al.  Adverse drug events in hospitalized patients A comparison of doctors, nurses and patients as sources of reports , 1999, European Journal of Clinical Pharmacology.

[23]  I. Edwards,et al.  Adverse drug reactions: definitions, diagnosis, and management , 2000, The Lancet.

[24]  I. Olkin,et al.  Adverse drug reactions in hospitalized patients: A critique of a meta-analysis. , 2000, MedGenMed : Medscape general medicine.

[25]  N. Moore,et al.  Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability , 2000, European Journal of Clinical Pharmacology.

[26]  M. Langman,et al.  Ulcer complications associated with anti‐inflammatory drug use. What is the extent of the disease burden? , 2001, Pharmacoepidemiology and drug safety.

[27]  J. Edwards,et al.  Extra Adverse drug reactions in hospital patients A systematic review of the prospective and retrospective studies , 2002 .

[28]  C. Poole,et al.  Preventable Drug-Related Hospital Admissions , 2002, The Annals of pharmacotherapy.

[29]  Disciplinary Committee,et al.  Royal Pharmaceutical Society of Great Britain , 2002 .

[30]  Karen M Kuntz,et al.  Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. , 2002, The New England journal of medicine.

[31]  A. Avery,et al.  Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study , 2003, Quality & safety in health care.

[32]  S. Dhillon,et al.  The incidence and nature of drug-related admissions to hospital , 2003 .

[33]  H. Beijer,et al.  Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies , 2002, Pharmacy World and Science.

[34]  Border Ireland,et al.  Chartered Institute of Public Finance and Accountancy (CIPFA) , 2006 .