TABLE C-16 Ambulatory Care: ADE Incidence

Study

Events per 100 Patients

ADEs per 100 Patient-Years

Proportion of ADEs Preventable

Gurwitz et al., 2003

Not given

5

28 percent (out of 1,523 ADEs in study)

Gandhi et al., 2000

18 drug complications

Not given

Not reported (394 drug complications in study)

Gandhi et al., 2003

27 ADEs

Not given

20 percent (out of 181 ADEs in study)

Incidence of ADEs During Ambulatory Care

The committee identified three studies on the rate of ADEs in ambulatory clinics (see Table C-16). In one study, using patient surveys and chart review, 394 (18 percent) patients reported a drug complication. Most of these complications were not noted in the medical chart, and it proved impossible to assess what proportion were preventable (Gandhi et al., 2000). A second study found that 162 (25 percent) of the 661 ambulatory care patients studied had experienced an ADE (Gandhi et al., 2003). Of the 181 ADEs found, 13 percent were serious, and 28 percent were ameliorable; 11 percent were attributed to the physician’s failure to respond to medication-related symptoms. A third study, involving Medicare patients, found an overall ADE rate of 50.1 per 1,000 patient-years and a preventable ADE rate of 13.8 per 1,000 patient-years (Gurwitz et al., 2003). Of the 38 percent of ADEs that were serious, 42.2 percent were preventable, and of the 62 percent of ADEs that were significant, 18.7 percent were preventable. The preventable ADEs occurred most often at the stages of prescribing (58.4 percent), monitoring (60.8 percent), and administration and patient adherence (21.1 percent).

INCIDENCE OF MEDICATION ERRORS IN PEDIATRIC CARE

It has become clear that the prescribing, dispensing, and administration of medications are associated with a substantial portion of the preventable medical errors that occur with children (Kaushal et al., 2001, 2004). Given the need to tailor all pediatric medication doses to body-size parameters (e.g., weight, body mass index), the fact that children are much less able than adults to double-check their own medications in any setting, and the wide range of appropriate doses for any medication based on the child’s size, children are uniquely vulnerable to medication errors. Accurate pediatric medication administration requires accurate weights; proper conversion of pounds to kilograms; the correct choice of appropriate preparations



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