The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan

The JADE study

Nobutaka Ayani, Mio Sakuma, Takeshi Morimoto, Toshiaki Kikuchi, Koichiro Watanabe, Jin Narumoto, Kenji Fukui

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Knowledge of the epidemiology of adverse drug events (ADEs) and medication errors in psychiatric inpatients is limited outside Western countries. The nature of ADEs and medication errors are important for improving the quality of care worldwide; therefore, we conducted the Japan Adverse Drug Events Study, a series of cohort studies at several settings in Japan. Methods: This report included 448 inpatients with 22,733 patient-days in a psychiatric hospital and psychiatric units at a tertiary care teaching hospital over 1 year. Four psychiatrists and two other physicians reviewed all medical charts and related documents to identify suspected incidents. The physicians later classified those incidents into ADEs, potential ADEs, medication errors, or exclusions and evaluated the severity and preventability if the incidents were events. Results: During the study period, we identified 955 ADEs and 398 medication errors (incidence: 42.0 and 17.5 per 1000 patient-days, respectively). Among ADEs, 1.4 %, 28 %, and 71 % were life-threatening, serious, and significant, respectively. Antipsychotics were associated with half of all ADEs. The incidence of medication errors was higher in medical care units than in acute and nursing care units (40.9, 15.6, and 17.4 per 1000 patient-days, respectively). The monitoring and ordering stages were the most common error stages (39 % and 34 % of all medication errors, respectively), and 76 % of medication errors with ADEs were found at the monitoring stage. Non-psychiatric drugs were three times as likely to cause ADEs with errors compared to psychiatric drugs. Conclusions: Antipsychotic use, inadequate monitoring, and treatment of physical ailments by psychiatrists may contribute to the high incidence of medication errors and ADEs among psychiatric inpatients in Japan. Psychiatrists should be cautious in prescribing antipsychotics or unfamiliar medications for physical problems in their psychiatric patients, and should monitor patients after medication administration.

Original languageEnglish
Article number303
JournalBMC Psychiatry
Volume16
Issue number1
DOIs
Publication statusPublished - 2016 Aug 30
Externally publishedYes

Fingerprint

Medication Errors
Drug-Related Side Effects and Adverse Reactions
Psychiatry
Inpatients
Japan
Epidemiology
Antipsychotic Agents
Incidence
Physicians
Hospital Units
Quality of Health Care
Psychiatric Hospitals
Tertiary Healthcare
Nursing Care
Teaching Hospitals
Pharmaceutical Preparations
Cohort Studies

Keywords

  • Adverse drug event
  • Epidemiology
  • Medication error
  • Patient safety
  • Psychiatry

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan : The JADE study. / Ayani, Nobutaka; Sakuma, Mio; Morimoto, Takeshi; Kikuchi, Toshiaki; Watanabe, Koichiro; Narumoto, Jin; Fukui, Kenji.

In: BMC Psychiatry, Vol. 16, No. 1, 303, 30.08.2016.

Research output: Contribution to journalArticle

Ayani, Nobutaka ; Sakuma, Mio ; Morimoto, Takeshi ; Kikuchi, Toshiaki ; Watanabe, Koichiro ; Narumoto, Jin ; Fukui, Kenji. / The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan : The JADE study. In: BMC Psychiatry. 2016 ; Vol. 16, No. 1.
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abstract = "Background: Knowledge of the epidemiology of adverse drug events (ADEs) and medication errors in psychiatric inpatients is limited outside Western countries. The nature of ADEs and medication errors are important for improving the quality of care worldwide; therefore, we conducted the Japan Adverse Drug Events Study, a series of cohort studies at several settings in Japan. Methods: This report included 448 inpatients with 22,733 patient-days in a psychiatric hospital and psychiatric units at a tertiary care teaching hospital over 1 year. Four psychiatrists and two other physicians reviewed all medical charts and related documents to identify suspected incidents. The physicians later classified those incidents into ADEs, potential ADEs, medication errors, or exclusions and evaluated the severity and preventability if the incidents were events. Results: During the study period, we identified 955 ADEs and 398 medication errors (incidence: 42.0 and 17.5 per 1000 patient-days, respectively). Among ADEs, 1.4 {\%}, 28 {\%}, and 71 {\%} were life-threatening, serious, and significant, respectively. Antipsychotics were associated with half of all ADEs. The incidence of medication errors was higher in medical care units than in acute and nursing care units (40.9, 15.6, and 17.4 per 1000 patient-days, respectively). The monitoring and ordering stages were the most common error stages (39 {\%} and 34 {\%} of all medication errors, respectively), and 76 {\%} of medication errors with ADEs were found at the monitoring stage. Non-psychiatric drugs were three times as likely to cause ADEs with errors compared to psychiatric drugs. Conclusions: Antipsychotic use, inadequate monitoring, and treatment of physical ailments by psychiatrists may contribute to the high incidence of medication errors and ADEs among psychiatric inpatients in Japan. Psychiatrists should be cautious in prescribing antipsychotics or unfamiliar medications for physical problems in their psychiatric patients, and should monitor patients after medication administration.",
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AU - Kikuchi, Toshiaki

AU - Watanabe, Koichiro

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