Resumen de Prevalence of negative clinical outcomes of medication in an emergency department, risk factors and preventability
Javier Merino Alonso, Gádor A. Callejón Callejón, Salvador Nuñez Díaz, Sara Ramos Linares, Carmen Rubio Armendáriz, José Antonio Martín Conde, Pilar Díaz Ruiz
Objectives: Analysing the prevalence of Negative Clinical Outcomes of Medication (NCOM) on patients attending the Emergency Department (ED) in a thirdtier hospital of Hospital Universitario Nuestra Señora de Candelaria. Identifying risk factors and those favouring their preventability.
Method: An observational, descriptive cross-sectional study was performed during one year, on patients attending the ED. Patients were selected through random two-stage sampling. In order to assess whether each patient suffered any NCOM, the Dáder methodology was used on the information obtained through a structured interview with each patient and review of the clinical records.
Results: 2,544 patients were included. 33.5% of patients suffered a NCOM. NCOM were due to drug ineffectiveness (19.1%), necessity problems (12.3%) and lack of safety (2.1%). Females suffered more NCOM than men (38.2% vs. 28.7%; p< 0.001); they also consumed more drugs (73.9% vs. 59.1%; p< 0.001). Some diagnosis presented higher prevalence in NCOM than No NCOM prevalence,especially respiratory diseases, mental diseases and blood and blood-forming organs diseases. Patients with NCOM were of more advanced age than those not suffering them (49 vs. 43; p< 0.005).
Drugs in therapeutic groups N (nervous system), M (musculoskeletal system) and J (anti-infective therapy) were the most highly related to NCOM occurrence.
74.8% of NCOM were preventable. Inadequate dosage for age, BMI or clinical status caused 38.9% of preventable ineffectiveness NCOM, and lack of indicated prophylaxis to prevent adverse drug reaction caused 22.7% of preventable lack of safety cases.
Conclusions: An older, higher Charlson Index or presenting more serious health problems, being female or consuming a higher number of drugs were confirmed as NCOM risk factors. High prevalence of NCOM in our hospital ED and their high preventability reveals the importance of this public health problem and implies that actions must be set up to improve pharmacotherapeutic follow up
