Slutsatsen i en studie utförd i England på 3695 patienter visar att ca en av sju patienter på sjukhus har en ADR (adverse Drug reaction), dvs hälsofarlig reaktion på medicinerna. ADR är en dels en signifikant faktor i ökad dödlighet samt ökar sjukhusvistelsen i snitt 0,25 dagar per patient. ADR ökar belastningen på sjukhusen avsevärt, och man efterlyser strategier att minska denna börda.
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• Medication administration errors (MAEs) were observed in two departments of a hospital for 20 days.
• The medication administration error rate was 14.9 percent. Dose errors were the most frequent (41 percent) errors, followed by wrong time (26 percent) and wrong rate errors. Ten percent of errors were estimated as potentially life-threatening, 26 percent potentially significant and 64 percent potentially minor.
• Medication-related problems (MRP) continue to occur at a high rate in ambulatory hemodialysis (HD) patients.
• Medication-dosing problems (33.5 percent), adverse drug reactions (20.7 percent), and an indication that was not currently being treated (13.5 percent) were the most common MRP.
• 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures.
The numbers of deaths reported in data sets varied 34-fold and were up to several 100-fold less than values based on extrapolations of surveillance programs.
• About 0.05 percent of all hospital admissions were certainly or probably drug-related.
• Incidence figures based on death certificates only may seriously underestimate the true incidence of fatal adverse drug reactions.
In one study of 200 patients, ADRs may have contributed to the deaths of two (one percent) patients.
In a survey of over 28,000 patients, ADRs were considered to be the cause of 3.4 percent of hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19 percent) represented the most common events, followed by metabolic and hemorrhagic complications (nine percent). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs and digoxin.
Approximately 5.3% of hospital admissions were associated with ADRs (adverse drug reactions). Higher rates were found in elderly patients who are likely to be receiving multiple medications for long-term illnesses. The methods used to detect ADRs are also likely to explain much of the variation in the reported ADR prevalence rates between different studies.
This retrospective, single-centre case study comprised of 289 patients dying between 1 January 2004 and 31 December 2004. Conclusion: Fatal ADRs are an important cause of death in hospitalized patients – 5.9% were suspected to have died from an ADR. Hemorrhages were seen in a majority of the fatal reactions, and antithrombotic agents or NSAIDs were implicated in most of these events.
Out of the 3695 patient episodes assessed for ADRs, 545 or 14.7%, experienced one or more ADRs. The only significant predictor of ADRs was the number of medicines taken by the patient. Each additional medication multiplying the hazard of an ADR episode by 1.14 (95% CI 1.09, 1.20). ADRs directly increased length of stay in 147 (26.8%) patients. The drugs most frequently associated with ADRs were diuretics, opioid analgesics, and anticoagulants.
In conclusion, approximately one in seven hospital in-patients experience an ADR, which is a significant cause of morbidity, increasing the length of stay of patients by an average of 0.25 days/patient admission episode. The overall burden of ADRs on hospitals is high, and effective intervention strategies are urgently needed to reduce this burden.