Improving dose-related adverse drug events among hospitalized older adults using a geriatric prescribing context

Background: Adverse drug events (ADEs) during hospitalization are a serious, yet preventable concern for older adults. Our institution designed a Geriatric Prescribing Context (GPC) to adjust doses for the older adult population but its impact on ADEs was unknown. The goal of this study was to assess any differences in rates of ADEs before and after its implementation in July 2017. Methods: We used relevant ICD-10 codes followed by confirmatory chart review to identify dose-related ADEs from 10 commonly used medications at our institution. We assessed differences in the number of admissions with an ADE before and after the GPC implementation using a test of binomial proportions. The pre-period was from July 2016 through June 2017 and the post-period was from August 2017 through July 2018. We compared the rate of ADEs per 1000 patient days between periods with a Poisson rate test and further examined any differences in harm categories using a Fisher's exact test. Results: The proportion of admissions with any dose-related ADEs significantly decreased from 0.0082 to 0.0037 after the GPC (p = 0.04). The rate of dose-related ADEs also declined from 2.5 per 1000 patient days to 1.1 per 1000 patient days (p = 0.001). Harm categories did not change significantly between time points (p = 0.30). Conclusions: Based on our list of relevant ICD-10 codes, the GPC was associated with lower dose-related ADEs for our selected medications among hospitalized older adults.