Page 214 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F5.7 Healthcare Advances, Research and Innovations 09:00 Room 421

Preventability of Drug Related Emergency Medical Ward (EMW) Admission of the Teaching Hospital of Hong

Kong: Can We Prevent It?
Wong KCV 1, Wan CK 2, Mok MY 3, Chan WK 2, Chan EWY4, Wong FFC 1, Wong CKI 5 Chui CMW 1, Tsui SH 2
1Department of Pharmacy, Queen Mary Hospital, 2Department of Accident and Emergency, Queen Mary Hospital, 3Department
of Medicine, The University of Hong Kong, Hong Kong, 4Department of Pharmacology and Pharmacy, The University of Hong
Kong, Hong Kong, 5School of Pharmacy, University College of London, UK

Introduction

Medication Related Visits (MRVs) are a substantial cause of hospital admissions. However, little is known about the incidence,
preventability and severity of MRVs resulting in emergency department visits in Hong Kong. To address this issue, we
conducted a retrospective survey in the Emergency Medical Ward (EMW) of a teaching hospital in Hong Kong.

Objectives

Medication-related visit (MRV) is an event or circumstance involving drug therapy that actually or potentially interferes with
the desired health outcome. The extent and characteristics of MRVs in the emergency department (ED) of Hong Kong are
unknown. The aim of this study is to determine the MRVs epidemiology in a bustling ED in Hong Kong.

Methods

Patients were selected randomly from EMW during the one-month study period (01/09/2015 to 30/09/2015). Clinical Data
Analysis and Reporting System (CDARS) was used to select fifteen beds daily at EMW on different time frames. Patients
were eligible to be included if they were either transferred to EMW or admitted due to MRVs. All medical records were
subsequently evaluated by one clinical pharmacist, one emergency physician and one medical physician independently to
determine whether the visit was the result of a MRV.

Results

Among the 479 patients (mean age: 65.5 years; female to male ratio: 1.5:1) included in the study, the EMW visit was identified
as medication related for 31 patients (6.5%); among them, 22 visits were deemed preventable. Severity was classified as
mild in 27.3% of the 22 cases, and moderate in 72.7%. The most common reasons for medication related visits were non-
adherence (39.3%), non-adverse drug reactions (27.9%) and use of wrong or suboptimal drug (11.5%). The most frequently
incriminated drug classes were: (1) cardiovascular drugs (n = 15; 68.2%); (2) analgesics including NSAIDs (n =4; 18.2%) and (3)
hypoglycemic agents (n = 2; 9.1%).

Wednesday, 4 May Conclusions

A medication-related cause was estimated to be 31/ 479 (~ 1 in 15). The figure may even be higher for the minor MRV cases
in daily EM visit that are not requiring EMW admission. MRVs leading to emergency department visits are frequent, and many
are preventable, confirming that there is a need to develop prevention strategies. Medication review, medication monitoring
and enhancing drug adherence strategies should be emphasized. Finally, further study with longer duration focusing on
MRVs prior to patient transferal to EMW should be conducted.

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