Hospital Admissions Related to Medication HARMstudy

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Hospital Admissions Related to Medication(HARM-st
udy)

• Patricia van den Bemt
• Anne Leendertse
• Toine Egberts

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90.000 preventable admissions a year
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literature
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literature

• little information on Dutch situation
• often retrospectively
• often one hospital
• little information on risk factors

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HARM

• prospective
• multicenter
• all admissions (no selection of wards)
• representative
• all types of hospitals
• from all Dutch regions

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aim
costs
risk factors
frequency and potential preventability
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methods
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related to medication

• medication error preventable
• dosage
• drug-drug interaction
• contra-indication
• non-compliance

• adverse drug reaction
• not preventable

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admissions
elective surgery
acute admissions
No-HARM
HARM
preventable
not preventable
cases
controls
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methodsdata collection

• cases and controls
• medical record
• community pharmacy
• laboratory data
• informed consent

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HARM causality and preventability

• assessment criteria
• first assessment by treating physician
• structured central assessment
• causality association drug - reason for
  admission
• preventability medication error as cause
• two assessors and consensus

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methodscausality assessment (Kramer)

• ADR known
• mentioned in drug information
• alternative explanation
• time relation

• classification
• probable
• possible
• unlikely

inclusion probable and possible
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methodsassessment of preventability (Schumock)

• indication
• co-medication
• dosage
• route of administration
• monitoring
• allergy
• drug-drug interaction
• contra-indication
• non-compliance
• dispensing error

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methodscosts

• costs per ward day (university/general)
• costs per ICU-day
• costs for one ER visit

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methodsdata-analysis

• Access, SPSS
• conditional logistic regression analysis

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results
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resultsfrequency
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resultsextrapolation to Dutch situation

• 5.6 of 600,000 acute admissions
• 34,000 admissions a year (2005)
• of which 16,000 potentially preventable

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reason for admissionpreventable HARMs
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drugs involved in HARMspreventable HARMs
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outcomepreventable HARMs
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costs potentially preventable HARMs
extrapolation per year in The Netherlands
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resultsdeterminants preventable HARMs
adjusted for polypharmacy and cognitive
dysfunction polypharmacy and living situation
polypharmacy, cognitive dysfunction,
non-compliance and renal function
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resultsdeterminants preventable HARMs
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resultsdeterminants preventable HARMs
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conclusion

• substantial frequency of HARMs
• almost 50 potentially preventable
• number of risk factors that are potential focus
  for improvement

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recommendations

• expansion medication check pharmacist
• renal function
• patient support
• cognitive dysfunction
• multidisciplinary approach
• polypharmacy
• non-compliance (including patient!)
• follow-up study (grant by ZonMw)
• intervention

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key messages

• frequent
• often potentially preventable
• by
• multidisciplinary support of high risk patients
• medication review
• sharing information between doctors-pharmacists
• renal function
• comorbidity

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key messages

• frequent
• often potentially preventable
• by
• multidisciplinary support of high risk patients
• medication review
• sharing information between doctors-pharmacists
• renal function
• comorbidity

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