Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study
- 1Division of Primary Care, School of Community Health Sciences, University Hospital, Nottingham NG7 2UH, UK
- 2Hayward House, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
- 3Pharmacy Department, Queens Medical Centre, University Hospital, Nottingham NG7 2UH, UK
- Correspondence to: Mrs R L Howard, Division of Primary Care, School of Community Health Sciences, University Hospital, Nottingham NG7 2UH, UK;
- Accepted 29 May 2003
Objective: To describe the drugs and types of medicine management problems most frequently associated with preventable drug related admissions to an acute medical admissions unit.
Design: Observation study.
Setting: Medical admissions unit in a teaching hospital in Nottingham, UK.
Participants: 4093 patients seen by pharmacists on the medical admissions unit between 1 January and 30 June 2001.
Main outcome measures: Proportion of admissions that were drug related and preventable, classification of the underlying causes of preventable drug related admissions, and identification of drugs most commonly associated with preventable drug related admissions.
Results: Of the admissions seen by pharmacists, 265 (6.5%) were judged to be drug related and 178 (67%) of these were judged to be preventable. Preventable admissions were mainly due to problems with prescribing (63 cases (35%)), monitoring (46 cases (26%)), and adherence to medication (53 cases (30%)). The drugs most commonly implicated were NSAIDs, antiplatelets, antiepileptics, hypoglycaemics, diuretics, inhaled corticosteroids, cardiac glycosides, and beta-blockers.
Conclusions: Potentially preventable drug related morbidity was associated with 4.3% of admissions to a medical admissions unit. In 91% of cases these admissions were related to problems with either prescribing, monitoring, or adherence.
Funding: This study was part funded by Wyeth Laboratories and part funded by NHS R&D.
AA conceived the study and was responsible for the design along with RH and MP. RH collected all the data and produced all the case summaries needed for the study. RH, AA and PH reviewed all of the cases. RH processed the data, entered it on to computer and analysed it with help from AA. All of the authors were involved in the interpretation of the results. RH and AA wrote the paper with PH and MP providing critical comments.