Research of Adverse Drug ED Visits. A new study has found that one in 250 individuals will experience an adverse drug reaction and require treatment in an emergency department (ED). Adverse drug event prevention was a target for the Patient Protection and Affordable Care Act of 2010.
The result was new programs to further the prevention effort, but adverse drug events continue to be a public health and safety issue in outpatient settings. Updated data concerning adverse drug reactions in the United States might help to focus medication safety programs in outpatient facilities.
In order to measure national estimates of emergency department visits and hospitalizations for adverse drug events, Nadine Shehab, PharmD, MPH (Master of Public Health), from the Division of Healthcare Promotion at the U.S. Centers for Disease Control and Prevention, and colleagues employed public health surveillance data from 58 emergency departments. These emergency departments participated in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Even Surveillance project.
The researchers used data from 42,585 cases and estimated that 4.0 emergency department visits per 1,000 individuals occurred annually between 2013 and 2014. Of these visits, 27.3 percent resulted in hospitalizations.
Personal injury attorneys at Parker Waichman LLP are actively reviewing potential lawsuits on behalf of individuals who have experienced adverse effects as a result of drugs.
Age and Adverse Drug Event Data
The researchers note that anticoagulants (blood thinners), antibiotics, and diabetes medications were involved in about 46.9 percent of adverse drug events, such as hemorrhage (excessive bleeding), moderate to severe allergic reactions, and hypoglycemia (low blood sugar).
Hypoglycemia symptoms may include anxiety, sweating, tremor, palpitations, nausea, and pallor. Hypoglycemia starves the brain of glucose energy which is essential for proper brain function. Lack of glucose energy to the brain may cause symptoms ranging from headache, mild confusion, abnormal behavior, loss of consciousness, seizure, and coma. Severe hypoglycemia can cause death, according to MedicineNet.com.
In addition, 34.5 percent of emergency department visits between 2013 and 2014 took place among adults over the age of 65, compared with 25.6 percent between 2005 and 2006. Older adults experienced the highest hospitalization rates of 43.6 percent.
Anticoagulants, diabetes agents, and opioid analgesics were implicated in about 59.9 percent of adverse events for this patient group.
Among children under five years of age (56.4percent) and among children and adolescents between six and 19 years of age (31.8 percent), antibiotics were the most common drug involved in adverse drug events. Among children and adolescents between 6 and 19 years of age (4.5 percent), antipsychotics were the second most common drug class implicated in adverse events.
“The American Psychiatric Association currently warns against using antipsychotics as first-line therapy in children and adolescents for conditions other than psychotic disorders; however, antipsychotic prescribing has increased sharply during the last two decades,” the researchers write.
The study authors note, “Improving recognition of adverse drug events by ED [emergency department] physicians is certainly important, but in the interim there is ample opportunity to improve patient safety by focusing attention on the adverse drug events consistently found to be common, serious, and measurable.”
Targeting adverse drug events due to anticoagulants and diabetes agents in the inpatient setting has contributed
“Targeting adverse drug events due to anticoagulants and diabetes agents in the inpatient setting has contributed to reductions in health care-related harm in U.S. hospitals. Achieving measurable reductions in outpatient adverse drug events may also require focusing on the most common drugs implicated and the highest risk patients,” study authors write.
Chad Kessler, MD, MPH, from Durham VA Medical Center in North Carolina, and colleagues write in an accompanying editorial, that gains in life expectancy are being eroded partially by the misuse of prescription medications.
“Even though this study specifically excluded ED visits for drug withdrawal, therapeutic failure, occupational exposure, intentional overdose, and recreational drug use, Shehab et al still found an estimated 1.3 million ED visits for [adverse drug events], nearly a 10 percent increase from 2005-2006,” they write.
Clinicians unfamiliar with patients or their medications are frequently reluctant to discontinue medication, and even when they are familiar with the patient, it is difficult to coordinate medications for multiple morbidities, according to Medscape.com.
In settings such as the ED, concerns about adverse drug events may not be fully addressed, as there is little time and there may be barriers to communicating with the patient’s primary care team.
“Collaboration is needed among physicians and other health professionals in primary care, specialty care, pharmacy, and emergency medicine to answer these questions in the quest for safer models of patient care,” the editorialists write.