A study team led by researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston noted that limited data exist about ADEs in the outpatient setting. In response, they sought to determine the incidence, severity, and preventability of ADEs in the outpatient setting, as well as identify potential prevention strategies. The results were published in BMJ Quality & Safety.
The analysis of ADEs involved a retrospective electronic health records review of outpatient encounters in 2018 in Massachusetts that included 13,416 outpatient encounters in 3,323 patients. The researchers identified triggers in the medical record, including medications, consultations, laboratory results, and others. If a trigger was detected, a further in-depth review was conducted by nurses and adjudicated by physicians to examine the relevant information in the medical record.
“This study is the largest recent study regarding outpatient ADEs; patients included a large population treated at multiple sites including primary care, specialty care and emergency departments, over a one-year period,” the authors pointed out in a press release.
The adult participants, who had a mean age of 60 years, had at least one outpatient encounter with a physician, nurse practitioner, or physician’s assistant in that calendar year. Patients were excluded from the study if the outpatient encounter occurred in outpatient surgery, psychiatry, rehabilitation, and pediatrics.
The study found 198 ADEs among 170 patients; most of them experienced one ADE (87%), 10% experienced two ADEs, and 3% experienced three or more ADEs.
The authors noted that the most frequent drug classes resulting in ADEs were cardiovascular (25%), central nervous system (14%), and anti-infective agents (14%). The authors further advised that severity was ranked as significant in 85%, 14% were serious, 1% were life-threatening, and there were no fatal ADEs. Of the ADEs, 22% were classified as preventable and 78% were not preventable.
The study team also identified 246 potential prevention strategies and found that 23% of ADEs had more than one prevention strategy possibility.
“Despite efforts to prioritize patient safety, medication-related harms are still frequent,” the researchers wrote. “These results underscore the need for further patient safety improvement in the outpatient setting.”
“The most desirable appeared to be AI [artificial intelligence]-related future prevention possibilities. Additional studies are needed to develop new prevention approaches and then assess their impact,” according to the study team.
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