ATC code | ATC category/medication name | Adverse medication event | Medication-related MET activations, n (%) N=81 | Potentially preventable medication-related MET activations, n (%) N=55 | Illustrative examples of potentially preventable medication-related MET activation | |
C01 | Cardiac therapy | 8 (9.9) | 6 (10.9) | |||
C01BD01 | Amiodarone | Error | Omission | 2 | 2 | Low blood pressure MET activation:first dose of ivabradine given despite persistent hypotension. Patient with dilated cardiomyopathy who had dobutamine infusion weaned over last 24 hours. |
Reaction | Type C | 1 | 0 | |||
C01CA17 | Midodrine | Error | Omission | 2 | 2 | |
C01DA02 | Glyceryl trinitrate | Reaction | Type C | 2 | 1 | |
C01EB17 | Ivabradine | Error | Scenario | 1 | 1 | |
C02 | Antihypertensives | 4 (4.9) | 4 (7.3) | |||
C02AC01 | Clonidine | Reaction | Type C | 1 | 1 | Low blood pressure MET activation: regular and as needed doses of clonidine given as part of multimodal postoperative pain regimen. Patient had undergone orthopaedic surgery the previous day and experienced severe postoperative pain. |
C02AC05 | Moxonidine | Error | Omission | 1 | 1 | |
C02CA01 | Prazosin | Error | Timing Omission | 1 1 | 1 1 | |
C03 | Diuretics | 20 (24.7) | 11 (20) | |||
C03CA01 | Furosemide | Error | Dose Omission Scenario | 3 3 5 | 0 3 4 | Low blood pressure MET activation: regular furosemide dose given despite significantly reduced oral intake. Frail elderly patient with congestive cardiac failure admitted with lower respiratory tract infection and documented low blood pressure and low oral intake with no supplementary fluids over preceding day. Low blood pressure MET activation: intravenous doses of furosemide given in addition to oral furosemide over last few hours to maintain fluid balance leading to excessive diuresis and symptomatic hypovolaemia. Patient with new heart failure secondary to non-ST elevation myocardial infarction. |
Reaction | Type A Type C | 2 7 | 0 3 | |||
C07 | Beta-blocking agents | 25 (30.9) | 19 (34.5) | |||
C07AA05 | Propranolol | Error | Scenario | 1 | 1 | High heart rate MET activation: morning dose of metoprolol omitted due to swallowing difficulty and no alternative prescribed/administered. Elderly patient admitted post fall with traumatic brain injury and facial fractures. Started regular oral metoprolol for rate control of new-onset rapid atrial fibrillation during admission. When swallowing difficulty noted, antibiotics and antiepileptics had been changed to intravenous route. High heart rate MET activation: metoprolol not recommenced at 48 hours post coronary artery bypass grafting. Patient had adequate blood pressure and had experienced runs of self-limiting atrial fibrillation postoperatively. Patient with ischaemic heart disease on regular metoprolol at home prior to surgery. |
Reaction | Type A | 2 | 0 | |||
C07AB02 | Metoprolol | Error | Dose Omission Scenario | 1 11 1 | 1 10 1 | |
Reaction | Type A | 1 | 1 | |||
C07AB03 | Atenolol | Error | Dose | 1 | 1 | |
Reaction | Type A | 1 | 1 | |||
C07AB07 | Bisoprolol | Error | Dose Omission | 1 1 | 1 1 | |
Reaction | Type A | 2 | 0 | |||
C07AB12 | Nebivolol | Error | Dose | 1 | 0 | |
C07AG02 | Carvedilol | Reaction | Type C | 1 | 1 | |
C08 | Calcium channel blockers | 7 (8.6) | 3 (5.5) | |||
C08CA01 | Amlodipine | Error | Omission | 2 | 1 | Worried MET activation: regular amlodipine dose not given despite hypertension. Patient admitted following mechanical fall with head strike. Known hypertension and other prescribed regular antihypertensives given. |
Reaction | Type A Type C | 1 1 | 0 1 | |||
C08CA13 | Lercanidipine | Error | Omission | 1 | 1 | |
C08DA01 | Verapamil | Error | Scenario | 2 | 0 | |
C09 | Agents acting on renin– angiotensin system | 17 (21) | 12 (21.8) | |||
C09AA04 | Perindopril | Error | Timing Omission Scenario | 1 1 1 | 1 1 1 | Low blood pressure MET activation: first dose of perindopril given on return to ward from percutaneous coronary intervention. Patient had required stenting for non-ST elevation myocardial infarction. Sedation was given for procedure and patient required treatment for hypotension during procedure (intravenous fluids and metaraminol). Low systolic blood pressure since admission 2 days prior. Low blood pressure MET activation: regular dose of candesartan restarted after cessation during hospital admission. Patient with heart failure with reduced ejection fraction on regular candesartan prior to hospital. |
Reaction | Type A Type C | 2 1 | 1 0 | |||
C09AA05 | Ramipril | Reaction | Type A Type C | 1 1 | 0 1 | |
C09CA01 | Losartan | Error | Omission | 1 | 1 | |
C09CA04 | Irbesartan | Error | Omission | 1 | 1 | |
C09CA06 | Candesartan | Error | Dose Omission Scenario | 1 1 1 | 1 1 1 | |
C09CA07 | Telmisartan | Error | Omission Scenario | 1 1 | 1 1 | |
C09D×04 | Valsartan and sacubitril | Reaction | Type C | 2 | 0 |
Type A=dose-related adverse medication reaction.
Type C=dose and time-related adverse medication reaction.
ATC, WHO Anatomical Therapeutic Chemical classification.