Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention

Abstract

Context: Medications represent a major cause of harm and are costly for hospitalized patients, but more is known about these issues in large academic hospitals than in smaller hospitals. Objective: To assess the incidence of adverse drug events (ADEs) in six community hospitals. Design: Multicenter, retrospective cohort study. Setting: Six Massachusetts community hospitals with 100 to 300 beds. Patients: From 109,641 adult patients hospitalized from January 2005 through August 2006, a random sample of 1,200 patients was drawn, 200 per site. Main outcome measures: ADEs and preventable ADEs. Methods: Presence of an ADE was evaluated using an adaptation of a trigger instrument developed by the Institute for Health Care Improvement. Independent reviewers classified events by preventability, severity, and potential for preventability by computerized physician order entry (CPOE). Results: A total of 180 ADEs occurred in 141 patients (rate, 15.0/100 admissions). Overall, 75% were preventable. ADEs were rated as serious in 49.4% and life threatening in 11.7%. Patients with ADEs were older (mean age, 74.6 years, p<0.001), more often female (60.3%, p=0.61), and more often Caucasian (96.5%, p<0.001) than patients without ADEs. Of the preventable ADEs, 81.5% were judged potentially preventable by CPOE. Conclusions: The incidence of ADEs in these community hospital admissions was high, and most ADEs were preventable, mostly through CPOE. These data suggest that CPOE may be beneficial in this setting. © 2009 Society of General Internal Medicine.