AHRQ report reveals increase in medication side effects and injuries

The number of people treated in U.S. hospitals for illnesses and injuries from taking medicines increased 52%-from 1.2 million to 1.9 million-between 2004 and 2008, according to an April 2011 report from the Agency for Healthcare Research and Quality (AHRQ). These adverse outcomes were a result of adverse drug reactions, adverse drug events, and medication errors.

Investigators determined that in 2008 the top 5 categories of medicines that accounted for more than 838,000 people treated and released from emergency departments were: unspecified medicines (261,600); pain killers (118,100); antibiotics (95,100); tranquilizers and antidepressants (79,300); and corticosteroids and other hormones (71,400).

For the approximately 1.9 million patients admitted to the hospital, the top 5 categories of medicines that caused side effects and injuries were corticosteroids (283,700); painkillers (269,400); blood-thinners (218,800); drugs to treat cancer and immune system disorders (234,300); and heart and blood pressure medicines (191,300).

Those 65 years of age and older accounted for 53% of hospitalized patients treated for side effects or other medication-related injuries; 30% were 45 to 64; 14% were 18 to 44; and 3% under age 18. Children and teenagers accounted for nearly one-quarter (22%) of emergency cases that were treated and released.

There are several factors that contribute to the large number of elderly hospital patients who experience side effects and injuries from taking the medications identified in the AHRQ report, noted Anna D. Garrett, PharmD, BCPS, member of the Editorial Advisory Board of Formulary's sister publication Drug Topics, and manager, Outpatient Clinical Pharmacy Programs, Mission Hospital in Asheville, N.C. “First, the number of people in this age group is increasing, “ she said. “Second, there are more and more drugs in these categories, so the odds go up. Third, fragmentation and poor hand-offs and communication between care settings play a huge role. Fourth, medication regimens are becoming more and more complex and thus difficult for patients to manage.”

Pharmacists can and should take a lead position in reducing the number of side effects and injuries from medications, added Garrett. She recommended that pharmacists become actively involved in admission and discharge processes to identify possible errors and problems before the patient leaves the hospital.

Caregivers also need to take the time to educate patients, in language they can understand, about the medication they are taking, said Garrett. “We need to get back to basics on this…what [the medication] is, what it’s for, major side effects, etc., so that people can advocate for themselves if something doesn’t seem right.”

Garrett noted that it’s not just pharmacists who can make inroads into reducing side effects and injuries from medications. At her hospital, the roles of technicians are being expanded to do medication histories and “play detective” when discrepancies are found. She noted that every patient that is scheduled for elective surgery at her hospital is interviewed by a technician, pharmacist, or both prior to admission to determine their medication history and to make sure “it’s right before they ever come in the door.”

The AHRQ report, “Medication-Related Adverse Outcomes in U.S. Hospitals and Emergency Departments, 2008,” can be accessed at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb109.pdf.