Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools

Purpose The results of a retrospective evaluation of the frequency and preventability of adverse drug events (ADEs) involving multiple drugs among hospital inpatients are reported. Methods Data collected in a previous cohort study of 180 actual ADEs and 552 potential ADEs (PADEs) at six community hospitals in Massachusetts were analyzed to determine the frequency and types of multiple-drug ADEs and the extent to which the ADEs might have been prevented using publicly available clinical decision-support (CDS) knowledge bases. None of the hospitals had a computerized prescriber-order-entry system at the time of data collection (January 2005–August 2006). Results A total of 17 ADEs (rate, 1.4 per 100 admissions) and 146 PADEs (rate, 12.2 per 100 admissions) involving multiple drugs were identified. The documented events were related to drug duplication ( n = 126), drug–drug interaction ( n = 21), additive effects ( n = 14), and therapeutic duplication ( n = 7) or a combination of those factors. The majority of actual ADEs were due to drug–drug interactions, most commonly involving opioids, benzodiazepines, or cardiac medications; about 75% of the PADEs involved excessive drug doses resulting from order duplication or the prescribing of combination drugs with overlapping ingredients, usually products containing acetaminophen and an opioid. It was determined that 5 (29.4%) of the ADEs and 131 (89.7%) of the PADEs could have been detected through the use of the evaluated CDS tools. Conclusion A substantial number of actual ADEs and PADEs in the community hospital setting may be preventable through the use of publicly available CDS knowledge bases.