It cannot be debated: medicine, specifically prescription medication, has revolutionized and enhanced the way healthcare professionals all over the world are able to care for their patients, directly responsible for improving patient outcomes. This is nothing new. In fact, medication has helped improve patient health tracing all the way back to circa 2112 BC when the first medical prescriptions appeared in ancient Sumer, the earliest known civilization in the historical region of southern Mesopotamia. However, and despite literally thousands of years of success stories, there is another side to prescription drug use.
Today marks the beginning of a blog series dedicated to medication safety in America, and how the healthcare community – specifically pharmacists – can step in to turn the tide on one of today’s top public health issues: adverse drug events (ADEs). However, before we talk about the solution, we must first understand the problem. An ADE is defined as an injury resulting from medical intervention related to a drug, including medication errors, adverse drug reactions, allergic reactions, and overdoses. As you’ll see, they’re all too common.
ADVERSE DRUG EVENTS – BY THE NUMBERS
It is important to note that ADEs are not confined to one isolated patient demographic or care setting; they can happen to anyone who takes medication, and they can happen anywhere – from hospitals to long-term care settings, and outpatient settings.
ADEs in inpatient settings (annually):
- Account for 1 in 3 of all hospital adverse drug events
- Account for ~2 million hospital stays
- Prolong hospital stays by 1.7-4.6 days
ADEs in outpatient settings (annually):
- Account for >3.5 million physician office visits
- Account for ~1 million emergency department visits
- Account for ~125,000 hospital admissions
And while the exact number of ADEs is not certain, the impact of ADEs has been documented and poses a significant public health problem. By some estimates, if it were a disease, ADEs would be the 3rd leading cause of death in the United States. However, before we can start talking about how to reduce ADEs, we must first understand why ADEs have become so prevalent.
We live in a society heavily reliant on medication to treat our multiple diseases, and treating multiple diseases requires taking multiple medications… often prescribed by multiple prescribers. No segment of the population exemplifies this scenario more than older Americans. Consider this August report published by the Center for Disease Control and Prevention, which found about a third of American adults aged 60-79 used five or more prescription drugs… in the past 30 days! Patients taking multiple drugs for multiple diseases, prescribed by multiple caregivers inherently leads to gaps in care, which are what ultimately allows patients to end up taking medications that do not interact well with one another and trigger an adverse drug event. Further complicating this issue is that it is not uncommon for the effects of an ADE (e.g. feeling tired, dizzy or nauseous) to be misdiagnosed as a new symptom of a new disease, leading to the patient being prescribed yet another drug. Rinse, wash, repeat.
Like families with multiple siblings, not all medications ‘get along.’ In fact – and if I may continue the sibling metaphor – some medications should never be put in the same room, let alone the same body. But remember: the large majority of ADEs are preventable, which would not only directly lead to saving patient lives, but lead to a safer and higher quality of health care services, reduced health care costs, and improved health outcomes. Still, each day, patients are continually and unknowingly prescribed medications that could trigger an adverse drug event. And while changing the prescribing practice of doctors could help, it is not the answer. The answer is to equip and empower medication experts – pharmacists – with a science-based tool that they can use to help prevent ADEs where they start: over the counter. Traditionally, drug-drug interactions have always been calculated on a 1:1 basis, and this is what we believe to be the true root cause of ADEs. Tabula Rasa HealthCare has tapped into cutting-edge science to build a medication safety tool, MedWise™, capable of identifying accumulative multi-drug interactions to provide a more holistic picture of the patient’s medication regimen while calculating the risk involved.
As cliché as it sounds, the first step in fixing any problem is to first acknowledge that there is, in fact, a problem. In the next installment of this three-part series, we’ll explore the five most common risk factors associated with adverse drug events. Then, we will expand on how MedWise is revolutionizing medication risk management and helping pharmacists have the precise tools they need to prevent and mitigate adverse drug events.
 “History of opium poppy and morphine,” Norn S, Kruse PR, Kruse E. https://www.ncbi.nlm.nih.gov/pubmed/17152761.
 Overview – Adverse Drug Events, Office of Disease Prevention and Health Promotion: https://health.gov/hcq/ade.asp.
Preventable Adverse Drug Reactions: A Focus on Drug Interactions, U.S. Food and Drug Administration: https://www.fda.gov/drugs/drug-interactions-labeling/preventable-adverse-drug-reactions-focus-drug-interactions.
 Leading Causes of Death, Center for Disease Control and Prevention, https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
 National Institute on Drug Abuse. Overdose Death Rates. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
Overview – Adverse Drug Events, Office of Disease Prevention and Health Promotion: https://health.gov/hcq/ade.asp.