Study shows how to reduce adverse drug events Published April 17, 2007 By Richard Gray TriWest Healthcare Alliance MALMSTROM AIR FORCE BASE, Mont. -- Doctors and pharmacists must change the way they provide medicines to outpatients to reduce adverse reactions to medications, concluded a three-phase research study conducted by a team of military, university and TriWest Healthcare Alliance physicians, pharmacists and nurses. The team initiated the study prompted by data that confirmed the Institute of Medicine's announcement in 1997 that error rates were much too high for the wellbeing of the public. The literature suggested that pharmacy-related errors could be successfully addressed on an outpatient basis. Taking prescription medicines may cause nearly 2 million adverse drug events annually and up to 10 percent are lifethreatening or fatal. A significant number can be prevented, said TriWest Medical Director Brian Casull, M.D., who led the Patient Safety-Adverse Drug Event Project, which began in 2001. "Up to one patient out of every three who are on medication may be at risk for an ADE at any given time," Dr. Casull said. The study concludes that ADEs can be reduced among outpatients with better education, and improved communication and record-keeping between physicians, pharmacists and patients. "The model predicted cost savings can be achieved by reducing ADEs, which results in less money spent treating ADEs," Dr. Casull said. "For every dollar spent on prescription medicines, $1.30 is spent to address the impact of ADEs through emergency room and hospital care." The study recommends that doctors improve their knowledge of drugs and clarify illegible and incomplete prescriptions before administering a drug, and that patient prescription information should be more readily available to doctors. Those at higher risk to suffer an ADE are: Patients who take five or more medications; Patients who take 12 or more doses per day; Patients whose medication regimen has changed four or more times in a year; Patients who have more than three chronic diseases; Patients who have a history of not complying with prescription instructions; Patients who take drugs that require therapeutic monitoring. ADE factors Age and sex (older and female); The number of pharmacies used in filling prescriptions; The number of health care providers prescribing medications; Beers List Drugs (medications that have high risk of causing adverse drug events in women and the elderly). Dr. Casull said the study recommends "safe practices" for using medications, including: Keep a current list of prescriptions including dosage, frequency and pharmacy name; Ask doctors to clearly write the medications purpose on any prescription; Keep medicines in their original containers complete with directions; Don't chew or break pills unless instructed; Don't store medications in the bathroom or in direct sunlight; Never take someone else's medication; Take a list of over-the-counter products in use and a list of allergies to medicines or food on visits to the doctor. Dr. Casull recommends asking these questions while at the doctor's office. 1. Is a generic version available? 2. Will the medicine work safely with other drugs and over-the-counter medications? 3. Are there any potential side effects or tests required when taking the medication? Dr. Casull advises patients to report any unusual reactions or side effects if switching from brand name to generic drugs. "An ADE can manifest itself in many ways, from a simple rash that clears by itself or an acute life-threatening allergic reaction that can impact breathing and heart rate," Dr. Casull said. "The most common symptoms that require hospitalization are allergic, such as itchy eyes or skin and difficulty breathing, and neurological signs such as passing out or unusual mental status changes. They also can present themselves as a worsening of medical symptoms that a patient already has." Among those participating in the study were Offutt and Peterson Air Force Bases, the United States Air Force Academy, and Fort Carson, an Army post serving as the control group. Others involved with the project were the University of Arizona School of Pharmacy , Express Scripts, and TriWest Healthcare Alliance's Healthcare Services and Quality Improvement departments. The military's health care program, TRICARE, embraced the study and is interested in conducting a study on a larger scale aimed at reducing ADEs among TRICARE's beneficiaries younger than 65.