… intent of use, and concurrent substance use. … Mital R, Lovegrove MC, Moro RN, et al. US emergency department …

… by age group, medication class, and intent of use. … Budnitz DS, Shehab N, Lovegrove MC, et al. US emergency …

Using data reported to the National Healthcare Safety Network, this study identified significant increases in the incidence of healthcare-associated infections from 2019 to 2020. The authors conclude that these findings suggest a need to return to conventional infection control and prevention practices and prepare for future pandemics.

The Institute for Safe Medication Practices (ISMP) classifies insulin as a high-risk medication. This study examines insulin mix-up errors that resulted in emergency department visits or other serious adverse events. Most cases of medication mix-up involved rapid-acting insulin. Recommended prevention strategies include increased patient education and human factors engineering.

Parents are advised to keep medications inaccessible to young children to avoid accidental ingestions. This study prospectively enrolled nearly 4,500 individuals calling poison control centers about unsupervised solid dose medication exposure in young children (ages 5 years and younger) to identify the types of containers from which young children accessed these medications. The majority of incidents (71.6%) involved children 2 years and younger. Incidents were equally divided among calls involving prescription-only medications, over-the-counter (OTC) projects requiring child-resistant packaging, and OTC projects not requiring such packaging. One-third of all incidents involved medication that had been removed from the original container; this was more likely in incidents involving prescription drugs compared to OTC drugs (adjusted odds ratio, 3.39; 95% CI, 2.87-4.00).  These findings suggest that unsupervised medication exposures in young children are just as often the result of adults removing medications from original packaging as the result of improper use or failure of child-resistant packaging.

Health care–associated infections (HAIs) are a key cause of preventable harm in hospitals. Successful programs to avert HAIs include the comprehensive unit-based safety program to reduce catheter-related bloodstream infections and the AHRQ Safety Program for Surgery to prevent surgical site infections. This survey of 12,299 patients at 199 hospitals on a single day enabled researchers to estimate the prevalence of HAIs in the United States. In 2015, 3.2% of hospitalized patients experienced an HAI, a 16% decrease compared to a similarly derived estimate in 2011. The most common HAIs were pneumonia and Clostridium difficile infections, while the biggest reductions were in urinary tract and surgical site infections. This data emphasizes the importance of identifying strategies to combat pneumonia in nonventilated patients, which remains common and less well-studied than other HAIs. A past PSNet perspective discussed the history around efforts to address preventable HAIs, including federal initiatives.

Adverse drug events (ADEs) in outpatient settings can cause significant morbidity and mortality. Updating a prior study, this surveillance study identified more than 40,000 ADEs among 58 emergency departments in the United States. Investigators estimated that 4 emergency department visits for ADEs occurred per 1000 patients annually during the study period, with more than one-quarter of these visits resulting in hospitalization. Antibiotic reactions were the most common ADE for children. Among patients age 65 or older, anticoagulants, diabetes medications, and opioids were most commonly implicated in ADEs, as seen in a previous study. Medications considered inappropriate for older adults according to Beers criteria were involved in less than 2% of ADEs. The authors conclude that preventing ADEs requires attention to older adults and to antibiotic, anticoagulant, diabetes, and opioid medications, consistent with recommendations from the 2014 National Action Plan for Adverse Drug Event Prevention.

Dietary supplements can cause harm, especially in combination with prescribed medication, and their use is increasing. This report from an established surveillance system sampled emergency department visits related to dietary supplements. The results suggest that adverse events related to dietary supplements cause 23,000 emergency department visits per year in the United States. Ingestions by unsupervised children accounted for nearly a quarter of the visits. Other common events included palpitations, chest pain, or tachycardia related to weight loss or energy supplements. The authors note that there is no legal requirement for supplement manufacturers to identify potential adverse effects on the products themselves, and they encourage clinicians to educate patients about potential adverse reactions.

Accidental ingestions of prescription medications by children pose serious safety risks. Prior efforts to mitigate this hazard include child-resistant packaging and public education about safe storage. This study used large databases to estimate that approximately 10,000 children under age 6 are emergently hospitalized following an accidental ingestion annually in the United States. Three-quarters of these events involved 1- or 2-year-old children. Opioids and benzodiazepines were the most common culprits, and 12 active ingredients accounted for nearly half of the hospitalizations. These findings suggest that strategies to specifically target a select group of high-risk medications could have a substantial impact on serious adverse drug events related to accidental ingestions.

Health care–associated infections (HAIs) are a serious and common cause of patient harm. The Centers for Disease Control and Prevention (CDC) created the National Healthcare Safety Network to provide information on incidence rates of infections, but most hospitals limit reporting to only certain complications. This multistate prevalence study found that approximately 4% of sampled patients had HAIs. Using a model to extrapolate these findings, nearly 650,000 patients in United States hospitals are estimated to have had an HAI in 2011. Infections associated with devices—including central lines, urinary catheters, and ventilators—have been a major focus of strategies to decrease HAIs, but together they accounted for only about a quarter of all HAIs. Clostridium difficile was responsible for more than 12% of infections, highlighting the importance of efforts to mitigate this life-threatening disease. A recent CDC report suggested the potential promise of antibiotic stewardship programs to decrease C. difficile rates.

According to this large study, nearly 100,000 emergency department visits and 30,000 hospitalizations in the United States each year are due to insulin-related hypoglycemia and errors. Patients older than 80 years were found to be at highest risk for these adverse events.

Emergency department visits for cold and cough medication–related adverse events among children younger than 3 years declined significantly following manufacturers' voluntary withdrawal from the market and label revisions.

Partnership for Patients set an ambitious goal to reduce preventable readmissions by 20% in 2013. Adverse drug events contribute significantly to undesired outcomes and provide an ongoing area for prevention strategies. This study used a national surveillance database and examined nearly 100,000 emergency hospitalizations attributed to adverse drug events in elderly patients between 2007 and 2009. Investigators found that nearly half the hospitalizations were in adults older than 80 years and two-thirds were due to unintentional overdoses. The most common medications implicated were warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents. The authors suggest that targeted strategies to minimize risk associated with these high-risk medications may reduce preventable hospitalizations in older adults.

This study found substantially reduced emergency department visits for over-the-counter (OTC) cough and cold medication–related adverse events. The authors advocate for greater efforts to improve packaging information and education around avoiding use of these high-risk OTC medications in infants.

… with insulin prescribing is discussed in an AHRQ WebM&M commentary . …

This study sought to characterize the frequency and causes of adverse drug events leading to emergency department visits in children. In contrast to adults, the majority of medication overdoses in children were due to unsupervised, accidental ingestions, while medication errors accounted for less than 15% of cases. Errors involving over-the-counter medications were more common than prescription medications, and the most common error was administering the wrong dose. Low health literacy is tied to misunderstanding prescription drug instructions, and a prior study successfully used pictogram-based education to reduce dosing errors in children. The study likely underestimates the true incidence of adverse drug events in children, as most cases are managed by poison control centers without requiring visits to a physician.

… This analysis of data from the Centers for Disease Control's National Healthcare Safety Network found that the overall …

This study found that adverse drug events from antibiotic use result in nearly 150,000 emergency department visits per year. An ultimately fatal case of an antibiotic adverse drug event is discussed in an AHRQ WebM&M commentary.

… prevent unintentional overdoses in toddlers. … Cohen AL, Budnitz DS, Weidenbach KN, et al. National surveillance of …

… focusing on use of Beers criteria medications. … Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication use …