Harm caused by the use or misuse of prescription medications leads to around two million visits to emergency departments, 700,000 hospital admissions and $1 billion in health care expenditures in Canada each year. Known as adverse drug events (ADEs), they rank between the fourth and sixth leading causes of death in Canada.
Dr. Corinne Hohl
While repeat ADEs are preventable, they have resulted in around 1,500 deaths in B.C. alone each year.
Dr. Corinne Hohl, an associate professor of emergency medicine and researcher with the Vancouver Coastal Health Research Institute (VCHRI), and her team are investigating the integration of Dr. Hohl’s ActionADE software with the provincial PharmaNet system, which has linked together B.C. community pharmacy prescription information in one centralized place since 1995.
Dr. Hohl’s precedent-setting ActionADE software makes it possible for the first time to connect hospital pharmacies with all community pharmacies in the province.
“ActionADE is groundbreaking because it links the community pharmacists into the circle of care, granting them access to adverse drug event information from hospitals whenever hospital care providers record an ADE into the ActionADE system,” says Dr. Hohl.
“We are finding that the ActionADE intervention prevents unintentional re-exposures to drugs that previously caused harm, which is exactly what we were hoping for.”
ActionADE improves communication across patients’ circle of care
First developed in 2013, ActionADE underwent several preliminary studies led by Dr. Hohl, including being piloted with 26 clinical pharmacists at Vancouver General Hospital in 2018. This was expanded to all clinical pharmacists at that hospital in 2019.
Dr. Hohl’s 2019 study found that, of the 1,178 patients with a diagnosed ADE, over one third had a repeat ADE — almost 40 per cent of which resulted in a hospital readmission. The study concluded that about 75 per cent of these repeat ADEs could have been prevented through monitoring and communication improvements.
Dr. Hohl’s current research study is tracking patient participants whose ADE is logged onto PharmaNet at Vancouver Coastal Health (VCH) or Providence Health Care (PHC) hospitals, community clinics or long-term care facilities.
Using back-end statistical monitoring built into the ActionADE platform, Dr. Hohl and her team found that one third of 500 patients with an ADE who were admitted to a VCH or PHC hospital emergency department continued to have their culprit medication re-prescribed at a community pharmacy.
Of these, the PharmaNet-linked ActionADE alert system — which displays a warning notification on a pharmacist’s monitor if they try to re-prescribe an offending medication — prevented one third of patients from receiving medication that would cause repeat ADEs.
“Through this research, we are seeing the problem of patient re-exposure to harmful medications happening in real-time,” says Dr. Hohl, who will recruit around 3,600 total participants for her ongoing study.
“We are finding that the ActionADE intervention prevents unintentional re-exposures to drugs that previously caused harm, which is exactly what we were hoping for.”
Dr. Corinne Hohl
“Our preliminary data confirms that this is really a problem of information-sharing, and that linking hospital and community pharmacies can play a pivotal role in preventing the re-dispensing of culprit medications.”
By alerting pharmacists to repeat ADEs, the ActionADE network could save countless patients from harm if implemented more broadly, and redistribute health care dollars to treat patients in-hospital and at out-patient care facilities, notes Dr. Hohl.
The additional safety net ActionADE provides can help patients overcome barriers surrounding language, lower levels of health literacy and several levels of complex comorbidities, all of which have the potential to cause confusion about which medications are safe and which can cause an ADE, adds Dr. Hohl.
“In limiting the potential for medications to cause harm, we are also optimizing patient health and the health benefits they receive from their medications,” she says.
This story originally appeared on the VCHRI website.