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Journal Article > Study
Hallas J, Haghfelt T, Gram LF, Grodum E, Damsbo N. J Intern Med. 1990;228:379-384.
In an attempt to characterize the socioeconomic impact of drug-related hospitalizations, this study examined more than 360 consecutive admissions to a cardiology service searching for drug events as a cause. Based on classifying “definite” and “probable” drug events, the rate of drug-related hospitalizations approached 6%. Admissions most frequently occurred in elderly patients and those on diuretics or digoxin. The authors conclude that although one third of the drug events were not likely preventable, the majority offered opportunity for intervention with directed educational efforts.
Journal Article > Review
Nolan L, O'Malley K. J Am Geriatr Soc. 1988;36:142-149.
This study reviewed existing evidence in order to evaluate the relationship between chronological age and adverse drug reactions. The authors provide a narrative summary and tables to illustrate trends noted in the more robust inpatient literature and the somewhat scarce outpatient literature for this relationship. Factors thought to contribute to adverse drug events are discussed, including multiple drug therapy, the presence of multiple disorders, severity of disease, and altered pharmacokinetics and pharmacodynamics. The findings suggest that elderly patients are not likely to experience an adverse reaction simply because of their age. Future studies must account for the factors more likely to impact poor outcomes with drug therapy.
Journal Article > Study
A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement.
Slight SP, Beeler PE, Seger DL, et al. BMJ Qual Saf. 2017;26:217-225.
Clinical decision support systems are intended to improve safety by providing clinicians with information about potential harms—principally harmful drug interactions and allergies—at the point of care. Analyzing more than 150,000 drug allergy warnings in the inpatient and outpatient settings within a single health care system, this study examined how often the warnings were overridden and the appropriateness of prescribers' reasons for doing so. Clinicians overrode 81% of warnings in hospitalized patients and 77% of alerts in outpatients. More than 96% of the overrides were judged appropriate by independent clinical reviewers. These proportions are similar to prior studies. A common appropriate reason for overriding was that the patient had actually tolerated the drug in question, leading the authors to call for improving the accuracy of allergy documentation in electronic medical records. A few classes of drugs accounted for a large proportion of overridden alerts, suggesting that enhancing the accuracy of allergy warnings for these drugs could significantly reduce the overall burden of alerts. Given that alert fatigue is an increasingly recognized patient safety hazard, creating tailored alerts could help clinical decision support systems achieve their potential to improve safety.