Outpatient drug safety: new steps in an old direction

Iatrogenic injury from adverse drug events (ADEs) is a common and often preventable problem in modern medical practice. Attention to this problem has focused on the inpatient hospital setting and healthcare professionals. However, most medication is prescribed and used outside of hospitals and is managed by patients or lay caregivers in homes or workplaces. To address the public health problem of outpatient drug safety, interventions to prevent adverse events must recognize the central role of the patient in medication management and environmental factors specific to the outpatient setting. Lessons and techniques from the field of injury prevention should guide the development and implementation of safety interventions. First, Haddon's phase‐factor matrix can be used to help conceptualize outpatient drug safety interventions. Second, interventions to improve outpatient drug safety should be patient‐centered and extend beyond patient education to include engineering innovations and enforcement strategies. Third, the sustainability of active versus passive interventions should be considered when choosing safety interventions. Published in 2006 by John Wiley & Sons, Ltd.

[1]  A. Trinkoff,et al.  Prevention strategies for infant walker-related injuries. , 1993, Public health reports.

[2]  J. Mercy,et al.  Patient safety efforts should focus on medical injuries. , 2002, JAMA.

[3]  W. Haddon A logical framework for categorizing highway safety phenomena and activity. , 1972, The Journal of trauma.

[4]  L. Reutter,et al.  A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention. , 1997, Journal of advanced nursing.

[5]  R. Perera,et al.  Self-monitoring of oral anticoagulation: a systematic review and meta-analysis , 2006, The Lancet.

[6]  M. Chassin Is health care ready for Six Sigma quality? , 1998, The Milbank quarterly.

[7]  C. Zwerling,et al.  Administrative and behavioral interventions for workplace violence prevention. , 2000, American journal of preventive medicine.

[8]  D. Bates,et al.  Incidence and preventability of adverse drug events among older persons in the ambulatory setting. , 2003, JAMA.

[9]  R. Holzman,et al.  Effect of Changing Needle Disposal Systems on Needle Puncture Injuries , 1987, Infection Control.

[10]  I. Arispe,et al.  Ambulatory care visits for treating adverse drug effects in the United States, 1995-2001. , 2005, Joint Commission journal on quality and patient safety.

[11]  D. Bates,et al.  Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. , 2003, Archives of internal medicine.

[12]  T S J Elliott,et al.  A review of sharps injuries and preventative strategies. , 2003, The Journal of hospital infection.

[13]  B. Ribner,et al.  Impact of a Rigid, Puncture Resistant Container System Upon Needlestick Injuries , 1987, Infection Control.

[14]  C. Keenan,et al.  Strategies to reduce medication errors in ambulatory practice. , 2004, Journal of the National Medical Association.

[15]  Nina S. Parikh,et al.  Inadequate functional health literacy among patients at two public hospitals. , 1995, JAMA.

[16]  T. Chorba,et al.  Assessing Technologies for Preventing Injuries in Motor Vehicle Crashes , 1991, International Journal of Technology Assessment in Health Care.

[17]  John W Hafner,et al.  Adverse drug events in emergency department patients. , 2002, Annals of emergency medicine.

[18]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[19]  John F Hurdle,et al.  High rates of adverse drug events in a highly computerized hospital. , 2005, Archives of internal medicine.

[20]  Ross Koppel,et al.  Medication Safety in Older Adults: Home‐Based Practice Patterns , 2005, Journal of the American Geriatrics Society.

[21]  W. Tierney,et al.  Adverse outpatient drug events--a problem and an opportunity. , 2003, The New England journal of medicine.

[22]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[23]  Joshua Borus,et al.  Adverse drug events in ambulatory care. , 2003, The New England journal of medicine.

[24]  Joshua Borus,et al.  Patient-reported medication symptoms in primary care. , 2005, Archives of internal medicine.

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

[26]  D. Pollock,et al.  Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance system. , 2005, Annals of emergency medicine.