IDENTIFYING AND PREVENTING ADVERSE DRUG EVENTS IN ELDERLY HOSPITALISED PATIENTS: A RANDOMISED TRIAL OF A PROGRAM TO REDUCE ADVERSE DRUG EFFECTS

Objectives: Evaluate the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting. Design: Randomised prospective study. Setting: The study was performed in France in the Paris area, in 16 rehabilitation geriatric centres of APHP (Assistance Publique – Hôpitaux de Paris). Patient capacity per centre varied from 15 to 57 with a total of 526. Participants: All the patients ≥ 65 years hospitalized during the 4 week study period were included. Measurements: During a first 2 week phase without intervention ADE’s were recorded in all centres. Then units were then randomised for an educational intervention or not. The educational phase lasted 1 week, without ADE tracking. Then, both types of units (I+ and I-) recorded ADEs for 2 weeks. Possible drug-related incidents were detected using a standardized check list (nurses) and a weekly review of all charts by investigators. Possible drug-related incidents were analysed by a group of reviewers selected from the authors to classify them as ADE or not. Results: 576 patients (mean age: 83.6 ± 7.9 years) were consecutively included. The mean number of drugs at inclusion was 9.4 ± 4.24 drugs per patient. 223 out of 755 events were considered “probable” ADEs (29.5%). Among the 223 ADEs, 62 (28%) could have been prevented. The main outcome of this trial was the change in the proportion of ADEs in elderly patients in the interventionunits, compared to the control group. The main errors were: to high a dose (26%), double therapy (21%), under dose (13%), inappropriate drug (13%), drug-drug interaction (6%), previous same adverse drug reaction (3%) and miscellaneous (11.18%). After a specific educational intervention program, there were fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004). Conclusion: Educational programs could help reduce the prevalence of ADEs by 14% and encourage physicians to change outdated prescription habits