Implementation of a System for Computerized Adverse Drug Event Surveillance and Intervention at an Academic Medical Center

• Objective: To describe the design and implementation of and early experience with a computerized system for detecting and preventing adverse drug events (ADEs) in hospitalized patients. • Methods: A computer system utilizing a rules engine was programmed using a combination of rules from previous authors plus new rules, selected to detect both ADEs and evolving unsafe conditions. Potential events detected by the system were reviewed by medication safety pharmacists and scored for causality and severity; clinical pharmacists responsible for the care of hospital patients reviewed the alerts for opportunities to intervene and prevent harm. Rules were modified and added or subtracted based on experience during the early implementation period. • Results: Preliminary evaluation of system performance during the first 2 months of operation showed high inter-observer agreement in evaluation of alerts, demonstrating that the computer system and evaluation process functioned in a standardized, reproducible manner. The positive predictive value of rules ranged from 0 to 0.67. The system detected 260 ADEs, or 3.7 ADEs per 100 admissions. Interventions in care were initiated in 206 patients as a result of alerts from the system. Automated surveillance detected 90% of all ADEs detected by surveillance and voluntary reporting combined during this period. • Conclusion: A computerized ADE surveillance system can effectively perform the dual functions of providing a medication “safety net” as well as detecting and documenting ADEs.

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