Reducing Adverse Drug Events in the Nursing Home Final rept. (July 1, 2000-June 30, 2004)

摘要

ADE's (Adverse Drug Experience) in the nursing home setting are most commonly associated with errors at the ordering and monitoring stages of pharmaceutical care, which may be particularly amenable to prevention strategies that utilize CCDS systems accompanying computerized order-entry. Methods: Two large academically-affiliated long-term care facilities served as the study sites. We assessed the incidence of ADEs, risk factors for ADEs, opportunities to provide information to the prescriber at the time of medication ordering, and the effectiveness of a CCDS system for preventing ADEs and reducing medication errors. Results: Pre-intervention, the overall rate of ADEs was 9.78 per 100 resident-months, with a rate of 4.05 preventable adverse drug events per 100 resident-months. Residents taking antipsychotic medications and anticoagulants were at the highest risk for experiencing preventable ADEs. The average nursing home with 100 residents, will have about 270 opportunities per month to improve the safe use of medications using a CCDS system. There was a trend toward reduced occurrence of ADEs and potential ADEs with the use of computerized physician order entry with a CCDS system. The rate ratio for preventable ADEs and potential ADEs was 0.78 (95% CI 0.58, 1.06) among residents in intervention units compared with those in control units.