Implementing and evaluating ActionADE to transform medication safety

Medications have transformed the lives of Canadians suffering from many debilitating conditions. However, medications may also cause harm. As medication use has increased, so has the incidence of adverse drug events (ADEs), harmful and unintended events related to medication use. Today, ADEs cause over 2 million emergency department visits across Canada each year, and are a leading cause of admissions. 

Preventing ADEs is not easy. Health care providers often unknowingly expose patients to the same or similar medications as ones that previously caused harm. For example: 

"I saw a diabetic who was discharged from hospital after being admitted for hypoglycemia [low blood sugar] due to glyburide [a blood sugar lowering drug]. The physician asked him to stop the glyburide and put him on gliclazide which has a lower risk of causing hypoglycemia. But he presented [a different hospital] with an even lower blood sugar. When I looked at his blister pack I discovered that both glyburide and gliclazide had been dispensed. The patient had been given a discharge prescription for gliclazide, but no note was made to discontinue glyburide, and neither his [family] doctor nor his pharmacist were aware of what had happened."

Hospital pharmacist, 2012 

Using combined professional and research expertise we will pilot-test, refine, implement and evaluate ActionADE, a new health information technology developed by my team to prevent repeat ADEs.