Drug Safety 2003; 26 (5): 353-362

Objective: Adverse drug reactions (ADRs) are a well-known cause of hospital Abstract admission. Nevertheless a quantitative estimate of the preventability of and physicians' awareness of these reactions is lacking. Study Design and Methods: Using intensive bedside and computer-assisted drug surveillance methods a 13-month prospective pharmacoepidemiological survey was carried out on patients admitted to two medical wards of the Erlangen-Nuremberg University Hospital in Erlangen, Germany. This study aimed to define the incidence of preventable and unavoidable ADRs. In addition we investigated the awareness of the physicians to ADRs at the time of admission and the rate of contraindicated pre-admission prescriptions. Results: In 78 (8.5%) of 915 (10.9%) admissions a total of 102 (42 preventable) community-acquired ADRs were detected on admission. In 45 (3.8%) of the admissions ADRs led directly to hospitalisation. 56.9% of the ADRs were not recognised by the attending physician on admission. Marked correlation was found between the awareness of ADRs and their probability and severity scores (r = 0.85 and r = 0.94, respectively; p < 0.05). The most frequently detected ADRs were due to direct toxicity and secondary pharmacological effects. Idiosyncratic reactions were often missed and 18.6% of all drugs prescribed prior to admission were contraindicated. Leading the list were diuretics, analgesics/NSAIDs and antipsychotics/sedatives. Conclusions: Awareness of existing ADRs on hospital admission and appropriate prescribing prior to hospital admission require attention. Early detection of ADRs on hospital admission can be achieved by the use of computer support systems. Many ADRs could be prevented by adhering to indications and contraindications. 354 Dormann et al. Background ADRs were the cause of hospital admission. Finally, the medical outcome was defined. Adverse drug reactions (ADRs) are amongst the As patients may have several ADRs simultane-most important causes of iatrogenic illness in terms ously, the total number of ADRs could be larger of morbidity and mortality. They have serious med-than the total number of patients having an ADR. ical-legal and economic consequences. [1-3] Numer-For analysis of patient-related factors (e.g. ADR ous studies have shown that ADR-related hospital rate) the first observed adverse reaction on hospital admissions comprise up to 10% of the total number admission was analysed. For analysis of ADR-relat-of admissions. [4-6] They contribute significantly to ed factors (e.g. probability, severity, mechanism, the socioeconomic burden of healthcare. [1] The preventability, outcome) all ADRs were taken into number of ADRs that remain unrecognised on ad-consideration. mission is unknown. The present study was …