Detection of Adverse Medicine Events by Pharmacists in Residential Aged Care Facilities: Secondary Analysis of Data From ReMInDAR Trial.

backgroundPharmacists often identify symptoms during medication reviews that may or may not be adverse medicine events (AMEs), but these have not yet been quantified. This study aimed to quantify the extent of these symptoms representing AMEs by comparing them with a known set of AMEs and symptoms listed in existing medicine-related symptom assessment tools.

methodA secondary analysis of data from the Reducing Medicine-Induced Deterioration and Adverse Reactions (ReMInDAR) trial was conducted. Adverse events or symptoms were extracted from pharmacists' progress notes, and their frequency and Medicine Likeliness Ratio (probability of being medicine-related) were determined. Pharmacist-recorded adverse events were compared to a subset of AMEs identified by a clinical panel, and agreement was assessed using Cohen's κ. Pharmacist-recorded adverse events or symptoms were also compared with those in the PHArmacotherapeutical Symptom Evaluation-20 questions (PHASE-20), and the Patient Reported Outcome Measure, Inquiry into Side Effects (PROMISE).

resultPharmacists recorded 3.1 symptoms per person; 68.8% of the symptoms had a medicine-likeness ratio ≥ 40.0%. The most prevalent medicine-related events recorded by pharmacists included falls (13.6%), swelling (7.1%), constipation (5.4%), nocturia (4.2%), shortness of breath (4.0%), bleeding (4.0%), nausea and vomiting (3.1%), dizziness (2.8%), drowsiness (2.3%), and rash (2.0%). Of the subset of 273 AMEs identified by the panel, 14.7% corresponded to adverse events recorded by pharmacists. The agreement between pharmacist-recorded and panel-identified AMEs was significant but low (κ = 0.074, p = 0.008). The majority of frequently detected medicine-related symptoms were in PROMISE (56.4% of recorded AMEs) and PHASE-20 (81.3% of recorded AMEs).

conclusionWhile pharmacists recorded a notable number and variety of adverse events or symptoms, underreporting and discrepancies were still observed. As items in the PHASE-20 aligned with most recorded events, further research is warranted to determine if it can help pharmacists in improving the detection and monitoring of AMEs. PLAIN LANGUAGE SUMMARY: Pharmacists often notice symptoms during medication reviews that may or may not be caused by the medicines. This study aimed to measure how often the symptoms reported by pharmacists were side effects of the medicines in use. We looked at data from a previous trial in aged care homes and reviewed the notes pharmacists wrote about possible symptoms or side effects. We then compared these to a list of known medicine-related problems identified by medical experts. On average, pharmacists recorded about three symptoms per person, and more than two-thirds of these were likely to be related to medicines. The most common side effects or symptoms included falling, swelling, difficulty passing stools, needing to urinate at night, feeling short of breath, bleeding, feeling nausea or vomiting, feeling dizzy, feeling sleepy, and skin rashes. However, only a small number of the problems recorded by pharmacists matched the expert-reviewed list. Most of the symptoms reported by pharmacists were also included in PHASE-20 symptom checklists, which is designed to help identify medicine-related symptoms. This suggests that this tool might support pharmacists to detect and track medicine-related problems. Further research is needed to explore how best to use this tool in practice.