Common Drugs Most Frequent Culprits in Emergency Hospitalizations

Study Involving Older Adults Points to Need for Better Controls, Guidelines

December 19, 2011 04:35 pm Matt Brown
[Stock photo-doctor running with patient on gurney]

Adverse drug events that lead to emergency hospitalization of older adults represent a direct consequence of clinical care and can be attributed to a few run-of-the-mill prescription drugs, according to a study( in the New England Journal of Medicine, or NEJM.

Using data gathered by the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project from 2007 through 2009, the study authors estimate that nearly 100,000 cases of emergency department visits and subsequent emergency hospitalizations due to adverse drug events occur each year in the United States. Of those hospitalizations, some two-thirds result from use of a few common medications.

story highlights

  • Nearly 100,000 emergency hospitalizations due to adverse drug events in older adults occur each year, according to a recent study in the New England Journal of Medicine.
  • The study estimates that warfarin, insulins, oral antiplatelet agents and oral hypoglycemic agents are responsible for two-thirds of these hospitalizations.

Specifically, the authors estimate that warfarin accounts for 33,171, or 33 percent, of such emergency hospitalizations in older adults, while insulins, oral antiplatelet agents and oral hypoglycemic agents are responsible for another 38 percent. Few hospitalizations -- 1.2 percent -- are thought to result from use of high-risk drugs, and only 6.6 percent are likely attributable to potentially inappropriate drugs.

AHRQ Offers Medication Reconciliation Toolkit

The Agency for Healthcare Research and Quality, or AHRQ, has released a resource designed to help hospitals, as well as post-acute care facilities, cut down on the number of adverse drug events that occur each year. The Medications at Transitions and Clinical Handoffs, or MATCH, Toolkit for Medication Reconciliation( provides hospitals and other health care facilities guidance on how to improve their medication reconciliation processes.

The free toolkit offers step-by-step instructions and relevant resources for all aspects of building and maintaining a comprehensive reconciliation process. It is based on the MATCH website developed by clinicians at Northwestern Memorial Hospital in Chicago with the support of AHRQ and in collaboration with Northwestern University and The Joint Commission.

"A sound medication reconciliation process must involve all caregiver disciplines, must be integrated into their daily workflow and must have the support of facility leadership to be successful," say the toolkit's authors. "The initial and subsequent improvement work to your medication reconciliation process will ultimately result in improved patient care and patient safety outcomes."

The report's authors characterize this incidence as "representing a substantial burden." For example, an estimated 21,010 hospitalizations for warfarin-related hemorrhage alone cost "probably hundreds of millions of dollars annually." Oral antiplatelet agents, the authors estimate, account for an additional 13,263 hospitalizations.

"The substantial contribution that (antiplatelet agents) make to hospitalizations in older adults is a reminder of the need for careful consideration of risks and benefits for individual patients and counseling about early recognition of hemorrhagic symptoms," say the authors.

According to Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, who is associate chair for the department of family and community medicine at the University of Arizona College of Medicine, several steps can be taken to reduce these types of events, including establishing a medical home for patients to avoid uncoordinated care among specialists.

"Make sure patients are not on medications they do not need or that will not really help them, monitor medication use carefully, and instruct patients not to make changes in medications or take new OTC (drugs) without discussing the change with you," he says.

The study also notes that the high number of hypoglycemia-related hospitalizations (an estimated 10,656 each year) suggests that current guidelines and performance measures may not reflect "optimal diabetes management" for all patients.

Again, says Campos-Outcalt, it comes down to knowing the individual patient. Overall, the AAFP does not favor a "strict 'tight' approach" to blood glucose management because it is not appropriate for everyone.

"We are in favor of a flexible approach, depending on patient circumstances," he notes.

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