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Title: Assessment of adverse drug events in hospitalised patients
Author: Alhrasen, Mohammed Nasser Mubarak
ISNI:       0000 0004 2740 8276
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2012
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Adverse drug events (ADEs), whether from drug-drug or drug-disease interactions, inappropriate prescribing, errors in administration, therapeutic failures, poor patient adherence to medication regimens, or insufficient inter-sector communication, can lead to serious negative outcomes for hospitalised patients. Epidemiological studies indicate that ADEs are relatively common in hospitalised patients and many are considered preventable. In the present research, two types of ADEs were assessed in hospitalised patients i.e. those resulting in extrinsic toxicity (preventable ADEs; pADEs), and those resulting in intrinsic toxicity (adverse drug reactions; ADRs). Furthermore, the present research explored the factors associated with the development of ADEs in hospitalised patients. The application of trigger tool methodology in detecting and preventing ADEs was also investigated. The assessment of ADEs retrospectively in the cardiology ward in the Antrim Area Hospital, N. Ireland, using trigger tool methodology, indicated that pADEs and ADRs are frequently encountered in hospitalised cardiovascular patients and ADEs continue to be an important risk of hospitalisation. ADEs were identified in 18.4 % of admissions, of which 51.9% were preventable and 48.1 % were ADRs. Approximately 54% of ADEs were identified at admission. The outcomes of the ADEs ranged from temporary harm (47.4%) to severe harm (11.3%). In a further evaluation of cardiovascular patient data and medication-related incident reports, collected by spontaneous/voluntary reporting (incident reporting system) in N. Ireland, were analysed with a focus on risk factors for individual cardiovascular medicines and factors involved in the occurrence of pADEs. The most frequently implicated variables in ADEs were related to age, the number of medications prescribed, length of stay, renal insufficiency, drug-drug interactions and laboratory values, whereas A&E, surgical wards, the action of nurses, antibiotics, anticoagulants and wrong dose administration had a significant positive association with the occurrence of pADEs. An evaluation of the application of trigger tool methodology demonstrated that this approach had clear benefits in identifying ADEs during a manual chart review. The results indicated that the sensitivity of the trigger tools used for identifying ADEs, pADEs and ADRs was 0.75, 0.8 and 0.71 respectively when compared to manual health record review. The trigger tool approach was also used to develop a targeted injury detection system (TIDS) which was evaluated by clinical pharmacists working on cardiovascular wards in the King Fahd Military Medical Complex in Saudi Arabia. This research demonstrated that concurrent and real-time triggers had clear benefits in guiding clinical pharmacist interventions in order to prevent emerging or mitigate actual ADEs in hospitalised cardiovascular patients. Application of the TIDS resulted in a clear trend of reduced incidence of ADEs (from 50.0% to 36.3% per alert), an increased number of clinical pharmacist interventions and a reduced time taken on the pharmacist rounds (with reduced time taken per clinical intervention). Trigger tools were also shown to have a potential role in evaluating and driving quality improvement in warfarin management within the Antrim Area Hospital (N. Ireland). The exploration of risk factors in hospitalised patients, together with the development of clinical event monitoring approaches, will help maximise the detection of ADEs and inform the further development of efficient clinical pharmacy services to patients at risk of drug-related problems.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available