Quality Prescribing

Adverse drug events (ADEs) remain an important, but largely preventable, source of harm to patients

The OIG report, Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries (February 2014) revealed that an estimated 33 percent of Medicare beneficiaries experienced adverse events or temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable.

The adverse events were classified into three clinical categories: events related to medication (37 percent), events related to ongoing resident care (37 percent), and events related to infections (26 percent). The percentage of preventable adverse and temporary harm events related to medications was 66%, the percentage of preventable events related to resident care was 57% and the percentage of preventable events related to infections was 52%.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, DC.

In addition, in October 2014 the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP) published its National Action Plan for Adverse Drug Event (ADE) Prevention. On the basis of national ADE data from inpatient and outpatient settings, three types of ADEs were considered to be common, clinically significant, preventable, and measureable, and were therefore selected as the high-priority targets of the ADE Action Plan. The three initial targets of the National Action Plan for ADE are:

Anticoagulants (primary ADE of concern: bleeding)
Diabetes agents (primary ADE of concern: hypoglycemia)
Opioids (primary ADE of concern: accidental overdoses/over-sedation/respiratory depression)

In response to the OIG report and National Action Plan for ADE prevention, AMDA developed a workgroup to produce simple, actionable guidance on these three classes of medications. In addition, AMDA assembled a broad coalition of clinical associations to help promote better prescribing practices. AMDA named this effort “Quality Prescribing.”