Prevention of Iatrogenic Complications

Risk Factors

The first step in prevention is to identify patients at high risk. Risk factors include the following:

Multiple chronic diseases: The greater the number of chronic diseases, the greater the risk that treatment of one disease will exacerbate others. For example, treatment of arthritis with an NSAID may exacerbate heart failure or chronic gastritis.

Multiple physicians: Having multiple physicians can result in uncoordinated care and polypharmacy. Consultation among multiple physicians every time one of them sees a common patient is difficult. As a result, a patient's therapeutic regimen is frequently changed without the input of the patient's other physicians, thereby increasing risk of iatrogenic complications.

Multiple drugs (polypharmacy) and inappropriate drugs: Taking multiple drugs concurrently and having multiple chronic diseases markedly increase risk of adverse drug-drug or drug-disease interactions. Risk of such interactions is particularly high among patients who are malnourished or who have renal failure. Additionally, certain drugs pose especially high risk of adverse effects in the elderly.

Hospitalization: Risks due to hospitalization include hospital-acquired infection, polypharmacy, and transfusion reactions. Hospitalized patients who have dementia or who are immobilized (eg, after surgery) are at high risk of iatrogenic complications.

Medical technology may contribute to iatrogenic complications, including brain damage during CPR, sudden death or MI after valvular replacement surgery, stroke after carotid endarterectomy, fluid overload after transfusions and infusions, and unwanted prolongation of life via artificial life support.

Prevention

Interventions that can prevent iatrogenic complications include the following:

Case management: Case managers facilitate communication among health care practitioners, ensure that needed services are provided, and prevent duplication of services. Case managers may be employed by physician groups, health plans, or community or governmental organizations. The frail elderly benefit the most from case management.

Geriatric interdisciplinary team: A geriatric interdisciplinary team evaluates all of the patient's needs and develops a coordinated care plan. Because this intervention is resource-intensive, it is best used in very complex cases.

Pharmacist consultation: A pharmacist can help prevent potential complications caused by polypharmacy and inappropriate drug use.

Acute Care for the Elderly (ACE) units: These units are hospital wards with protocols to ensure that elderly patients are thoroughly evaluated for potential iatrogenic problems before problems occur and that such problems are identified and appropriately managed.

Advance directives: Patients are encouraged to prepare advance directives, including designation of a proxy to make medical decisions. These documents can help prevent unwanted treatment for critically ill patients who cannot speak for themselves.

This topic was last updated July 2005.