Adverse Drug Events

Recognizing and Mitigating Adverse Drug Events in Emergency Department Patients

Towards Improved Medication Safety: A Provincial Program for Adverse Drug Event Screening and Surveillance in Emergency Departments

Strategic Leader: Corinne M. Hohl

Adverse drug events, the unintended and harmful consequences of medication use, cause over 300,000 ED visits in British Columbia annually. Of these, 70% are preventable. Patients with adverse drug events spend more days in acute care hospitals, have more frequent outpatient healthcare encounters, and incur double the health care cost compared with other patients. Presently, 40% of adverse drug events are misdiagnosed, leading to treatment delays and worse patient outcomes.

Vision
Our vision is to improve the health of British Columbians by ensuring timely recognition and optimal management of adverse drug events in EDs. We will accomplish this by developing, evaluating and implementing best practices locally, provincially and nationally. We will improve access to acute care beds by reducing health services utilization and costs associated with preventable adverse events.

Long Term Goals
We plan to develop the first provincial adverse drug event surveillance system that will allow us to improve patient safety by monitoring adverse drug event trends, and provide data to prioritize, develop and evaluate quality improvement projects for improved care delivery. This platform, the first of its kind internationally, will also provide robust data for comparative drug safety and effectiveness research to support national drug licensing and provincial drug-coverage decisions. We will expand from existing projects aimed at improving clinical care delivery and health systems management, to research in pharmacoepidemiology. We will focus on evaluating high-priority medications based on queries developed by the Ministry of Health and the Drug Safety and Effectiveness Research Network.

Short Term Goals

  • To validate and implement a prospective screening tool in EDs provincially to improve the recognition, treatment and documentation of adverse drug events in this practice setting.
  • To develop methods to document adverse drug events within electronic health records to enable electronic documentation of adverse drug events as well as their communication between care providers (e.g., between physicians, pharmacists and nurses) and across healthcare sectors (e.g., between hospitals, community-based providers and outpatient pharmacies) to improve patient care and reduce recurrent adverse drug events.
  • To create a provincial electronic platform to document adverse drug events. This data platform will serve as the basis for planned projects in quality improvement, pharmacosurveillance and pharmacoepidemiology.

Key Partners and Stakeholders
We have established partnerships with the PharmaNet Division of the Ministry of Health, Health Authorities, Health Canada, the Canadian Institute for Health Information, and patient safety organizations. Our goals support provincial initiatives to reduce polypharmacy, implement medication reconciliation, and improve care for the elderly and those with complex co-morbidities. They support national legislation, introduced in 2014, that mandates reporting of serious adverse drug reactions.

Work to Date
Twelve percent of ED visits in British Columbia are attributable to the adverse effects of medications. We have developed a screening strategy to identify patients at high-risk of adverse drug events, to reduce their high rate of misdiagnosis. A health systems intervention we have developed, and implemented has resulted in a 10% length of hospital stay reduction.