Volume 61, Issue 11 p. 1894-1899
Clinical Investigations

Adverse Drug Events After Hospital Discharge in Older Adults: Types, Severity, and Involvement of Beers Criteria Medications

Abir O. Kanaan PharmD

Corresponding Author

Abir O. Kanaan PharmD

MCPHS University, Worcester, Massachusetts

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

Address correspondence to Abir O. Kanaan, 19 Foster Street, Worcester, MA 01608. E-mail: [email protected]Search for more papers by this author
Jennifer L. Donovan PharmD

Jennifer L. Donovan PharmD

MCPHS University, Worcester, Massachusetts

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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Nerissa P. Duchin BS

Nerissa P. Duchin BS

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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Terry S. Field DSc

Terry S. Field DSc

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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Jennifer Tjia MD, MSCE

Jennifer Tjia MD, MSCE

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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Sarah L. Cutrona MD, MPH

Sarah L. Cutrona MD, MPH

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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Shawn J. Gagne BA

Shawn J. Gagne BA

Meyers Primary Care Institute, Worcester, Massachusetts

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Lawrence Garber MD

Lawrence Garber MD

Meyers Primary Care Institute, Worcester, Massachusetts

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Peggy Preusse RN

Peggy Preusse RN

Meyers Primary Care Institute, Worcester, Massachusetts

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Leslie R. Harrold MD, MPH

Leslie R. Harrold MD, MPH

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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Jerry H. Gurwitz MD

Jerry H. Gurwitz MD

Meyers Primary Care Institute, Worcester, Massachusetts

University of Massachusetts Medical School, Worcester, Massachusetts

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First published: 01 October 2013
Citations: 78

Abstract

Objectives

To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period after hospitalization in older adults.

Design

Clinical pharmacists reviewed the ambulatory records of 1,000 consecutive discharges.

Setting

A large multispecialty group practice closely aligned with a Massachusetts-based health plan.

Participants

Hospitalized individuals aged 65 and older discharged home.

Measurements

Possible drug-related incidents occurring during the 45-day period after hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

Results

At least one ADE was identified during the 45-day period in 18.7% (n = 187) of the 1,000 discharges. Of the 242 ADEs identified, 35% (n = 84) were deemed preventable, of which 32% (n = 27) were characterized as serious, and 5% (n = 4) as life threatening. More than half of all ADEs occurred within the first 14 days after hospitalization. The percentage of ADEs in which Beers Criteria medications were implicated was 16.5% (n = 40). Beers criteria medications with both a high quality of evidence and strong strength of recommendation were implicated in 6.6% (n = 16) of the ADEs.

Conclusion

ADEs are common and often preventable in older adults after hospital discharge, underscoring the need to address medication safety during this high-risk period in this vulnerable population. Beers criteria medications played a small role in these events, suggesting that efforts to improve the quality and safety of medication use during this critical transition period must extend beyond a singular focus on Beers criteria medications.