Abstract：
BACKGROUND: Limited data exist regarding adverse drug events (ADEs) in the outpatient setting. The objective of this study was to determine the incidence, severity, and preventability of ADEs in the outpatient setting and identify potential prevention strategies.
METHODS: We conducted an analysis of ADEs identified in a retrospective electronic health records review of outpatient encounters in 2018 at 13 outpatient sites in Massachusetts that included 13 416 outpatient encounters in 3323 patients. Triggers were identified in the medical record including medications, consultations, laboratory results, and others. If a trigger was detected, a further in-depth review was conducted by nurses and adjudicated by physicians to examine the relevant information in the medical record. Patients were included in the study if they were at least 18 years of age with at least one outpatient encounter with a physician, nurse practitioner or physician\'s assistant in that calendar year. Patients were excluded from the study if the outpatient encounter occurred in outpatient surgery, psychiatry, rehabilitation, and paediatrics.
RESULTS: In all, 5% of patients experienced an ADE over the 1-year period. We identified 198 ADEs among 170 patients, who had a mean age of 60. Most patients experienced one ADE (87%), 10% experienced two ADEs and 3% experienced three or more ADEs. The most frequent drug classes resulting in ADEs were cardiovascular (25%), central nervous system (14%), and anti-infective agents (14%). Severity was ranked as significant in 85%, 14% were serious, 1% were life-threatening, and there were no fatal ADEs. Of the ADEs, 22% were classified as preventable and 78% were not preventable. We identified 246 potential prevention strategies, and 23% of ADEs had more than one prevention strategy possibility.
CONCLUSIONS: Despite efforts to prioritise patient safety, medication-related harms are still frequent. These results underscore the need for further patient safety improvement in the outpatient setting.
METHODS: We conducted an analysis of ADEs identified in a retrospective electronic health records review of outpatient encounters in 2018 at 13 outpatient sites in Massachusetts that included 13 416 outpatient encounters in 3323 patients. Triggers were identified in the medical record including medications, consultations, laboratory results, and others. If a trigger was detected, a further in-depth review was conducted by nurses and adjudicated by physicians to examine the relevant information in the medical record. Patients were included in the study if they were at least 18 years of age with at least one outpatient encounter with a physician, nurse practitioner or physician\'s assistant in that calendar year. Patients were excluded from the study if the outpatient encounter occurred in outpatient surgery, psychiatry, rehabilitation, and paediatrics.
RESULTS: In all, 5% of patients experienced an ADE over the 1-year period. We identified 198 ADEs among 170 patients, who had a mean age of 60. Most patients experienced one ADE (87%), 10% experienced two ADEs and 3% experienced three or more ADEs. The most frequent drug classes resulting in ADEs were cardiovascular (25%), central nervous system (14%), and anti-infective agents (14%). Severity was ranked as significant in 85%, 14% were serious, 1% were life-threatening, and there were no fatal ADEs. Of the ADEs, 22% were classified as preventable and 78% were not preventable. We identified 246 potential prevention strategies, and 23% of ADEs had more than one prevention strategy possibility.
CONCLUSIONS: Despite efforts to prioritise patient safety, medication-related harms are still frequent. These results underscore the need for further patient safety improvement in the outpatient setting.
摘要：
背景：关于门诊药物不良事件（ADE）的数据有限。这项研究的目的是确定发病率，严重程度,和ADE在门诊环境中的可预防性，并确定潜在的预防策略。
方法：我们对2018年马萨诸塞州13家门诊患者的回顾性电子健康记录审查中发现的ADE进行了分析，其中包括3323例患者中的13416例门诊患者。在医疗记录中发现了触发器，包括药物，协商,实验室结果,和其他人。如果检测到触发,由护士进行了进一步的深入审查,并由医师裁定,以检查病历中的相关信息.如果患者年龄至少为18岁，至少有一次与医生的门诊接触，则将其纳入研究。该日历年的执业护士或医师助理。如果门诊手术发生在门诊手术中，则将患者排除在研究之外，精神病学,康复,和儿科.
结果：总而言之，5%的患者在1年内经历了ADE。我们在170名患者中确定了198名ADE，平均年龄为60岁。大多数患者经历过一次ADE（87％），10%经历过两次ADE，3%经历过三次或更多次ADE。导致ADE的最常见药物类别是心血管（25％），中枢神经系统（14%），和抗感染药（14%）。严重程度在85%中被列为显著，14%是严重的，1%有生命危险,也没有致命的ADE.在ADE中，22%被归类为可预防，78%被归类为不可预防。我们确定了246种潜在的预防策略，23%的ADE有不止一种预防策略的可能性。
结论：尽管努力优先考虑患者安全，与药物相关的危害仍然很常见。这些结果强调了在门诊环境中需要进一步改善患者安全性。
方法：我们对2018年马萨诸塞州13家门诊患者的回顾性电子健康记录审查中发现的ADE进行了分析，其中包括3323例患者中的13416例门诊患者。在医疗记录中发现了触发器，包括药物，协商,实验室结果,和其他人。如果检测到触发,由护士进行了进一步的深入审查,并由医师裁定,以检查病历中的相关信息.如果患者年龄至少为18岁，至少有一次与医生的门诊接触，则将其纳入研究。该日历年的执业护士或医师助理。如果门诊手术发生在门诊手术中，则将患者排除在研究之外，精神病学,康复,和儿科.
结果：总而言之，5%的患者在1年内经历了ADE。我们在170名患者中确定了198名ADE，平均年龄为60岁。大多数患者经历过一次ADE（87％），10%经历过两次ADE，3%经历过三次或更多次ADE。导致ADE的最常见药物类别是心血管（25％），中枢神经系统（14%），和抗感染药（14%）。严重程度在85%中被列为显著，14%是严重的，1%有生命危险,也没有致命的ADE.在ADE中，22%被归类为可预防，78%被归类为不可预防。我们确定了246种潜在的预防策略，23%的ADE有不止一种预防策略的可能性。
结论：尽管努力优先考虑患者安全，与药物相关的危害仍然很常见。这些结果强调了在门诊环境中需要进一步改善患者安全性。
