Evaluation of adverse drug reactions in emergency department practice

De Andrés Lázaro AM, Sevilla Sánchez D, Ortega Romero M, Codina Jané C, Ribas Sala J, Sánchez Sánchez M

Objective: To assess the incidence of adverse drug reactions (ADRs) in the emergency

department of a tertiary care hospital, to determine the characteristics of the ADRs, to

identify related risk factors, and to evaluate medication errors associated with

preventable ADRs.

Methods: Descriptive observational study based on data extracted from medical

records. Patients admitted to hospital after attendance in the emergency department

over a 3-month period were included. ADRs were found following a previously

established method to identify ADR clues, or triggers, in patient records. The Karch-

Lasagna scale and the Hallas algorithm were used to evaluate causality, and the

Schumock-Thornton questionnaire was used to assess ADR preventability. All events that

were candidates for classification as ADRs were validated by 2 data collectors.

Results: In the records for the 237 patients included, 31 ADRs were detected (incidence,

13%). Most of the ADRs could be assigned a possible (61%) or probable (29%) cause.

Forty-five percent of the ADRs were caused by medication errors and could have been

prevented. The most common preventable ADRs were hypo- or hyperglycemia related to

antidiabetic medication. The most common errors involved failure to prescribe a

necessary medication (50%) or failure to administer one (21%). The most common

unavoidable ADRs were tachycardia and hyperglycemia related to salbutamol and

corticosteroids, respectively. The only factors associated with a higher prevalence of

ADRs were the number of drugs administered in the emergency department and

admission to the acute-care section of the department.

Conclusions: The incidence of ADRs in this study was high and preventable events were

detected. These findings are consistent with evaluations of ADRs in the hospital setting.

Codina Jané C, De Andrés Lázaro AM, Ortega Romero M, Ribas Sala J, Sevilla Sánchez D, Sánchez Sánchez M