Nursing home injuries from adverse drug events found more common than previously identified

According to the findings of a study in The American Journal of Medicine, largely preventable injuries from adverse drug events in long-term care facilities are more common than previously documented.

“This study confirms that drug-related injuries continue to be a major problem in the long-term care setting,” stated lead author Jerry H. Gurwitz, MD, Dr John Meyers Professor of Primary Care Medicine and professor of medicine and family medicine & community health at the University of Massachusetts Medical School (UMMS), and the executive director of the Meyers Primary Care Institute (MPCI), which directed the study.

“This makes for a compelling argument for the use of information technology and management systems that can improve communications and decision-making among physicians, nurses and staff, to prevent these kinds of events,” he said.

Dr. Gurwitz and a team of physicians and pharmacists reviewed patient records at two large academic long-term care facilities with a combined total of 1,229 beds. The researchers looked at patient records covering an eight-month period for one site (December 2000 through July 2001) and a nine-month period (December 2000 through August 2001) for the other, identifying 815 injury causing adverse drug events.
Of those events, 590 were deemed “less serious” (including skin rashes, falls without associated fracture, bleeding not requiring transfusion or hospitalization, and medication-induced drowsiness), 188 “serious,” 33 “life-threatening,” and four events were fatal (more severe events included delirium, falls resulting in fracture, bleeding requiring transfusion, hypoglycemia., and kidney problems).

Typically, the events were caused by errors in drug prescribing and monitoring, including using the wrong dose of a medication, prescribing drugs that interacted with each other, and failing to watch closely for drug side effects. Errors in the dispensing and administration of drugs were less commonly associated with adverse events.

The data translated into a combined rate of nearly 10 adverse drug events per month for every 100 residents of the long-term care facilities. Additionally, the researchers concluded that 42 % of all the adverse drug events and 61% of the serious, life-threatening and fatal adverse events were preventable.

The current study found the rate of adverse drug events to be five times higher in the academic facilities than in the community-based nursing homes that were the objects of a study in 2000 published by Gurwitz’s team. An academic long-term care facility is identified by affiliation with a medical school and its on-site research and training programs. The higher rates of adverse events at those facilities give researchers cause for concern.

“We now believe that our previous studies drastically underestimated the rate of these adverse events in the long-term care setting,” said co-author of both studies Terry S. Field, DSc, associate professor of medicine at UMMS and an MPCI epidemiologist.

“The academic centers in our current study are exceptional facilities strongly committed to improving patient care and safety,” he observed, “and with many more resources than community nursing homes. So if we’re seeing these rates at these facilities, we believe they must occur at similar or higher rates at most nursing homes in this country.”

Presently, 1.6 million people reside in long-term care facilities in the United States. If the current study’s findings are extrapolated and applied to that total, it can be estimated there are some 1.9 million adverse drug events yearly, some 40% of which are preventable, and approximately 86,000 life-threatening or fatal adverse drug events each year in the US, of which nearly 70% may be preventable.

“This seems to be a major safety issue for some of our most vulnerable patients,” Gurwitz said. “We must develop new approaches for making the use of medications less prone to errors and risk for older patients in nursing homes.” He and his team advocate for increased involvement by nursing home residents’ relatives in their care, in addition to improvements in technology and management systems to deal with the proper ordering and monitoring of medications.

“So engagement of family members in the care of their older relatives is very important. People should be aware of the drugs that are being prescribed, the reasons for their use, and potential drug side effects; and they should report any changes they notice in their relative’s condition.”

SOURCE: Gurwitz JH, Field TS, Judge J, Rochon P, Harrold LR, Cadoret C, Lee M, White K, LaPrino J, Erramuspe-Mainard J, DeFlorio M, Gavendo L, Auger J, Bates DW: “The incidence of adverse drug events in two large academic long-term care facilities,”
The American Journal of Medicine - March 2005 (Vol. 118, Issue 3, Pages 251-258).