Computerized surveillance of adverse drug reactions in hospital: Implementation

AbstractObjective: To implement and measure the effects of automatic computerized laboratory signals (ALS) as a detection support tool of adverse drug reactions (ADRs) in hospital. Methods: This was a prospective observational study of a total of 192 patients (199 sequential medical admissions) during a 2-month period in a 34-bed medical ward at the Hadassah University Hospital, Jerusalem, Israel. The study involved the routine (daily) distribution to staff physicians of lists of automatic signals generated from computerized laboratory data as potential indicators of ADRs. Patient charts were reviewed by the clinical pharmacology team for ADRs and to see whether these were recognized by the staff physicians. Results: Seventy-one ADRs were detected in 64 of the 199 (32%) admissions. Twenty-seven per cent of the ADRs were serious, 9% of the admissions were due to ADRs. Two hundred and ninety-five ALS were generated involving 69% of the admissions. Sixty-one per cent of the ADRs were identified by ALS. ALS were present in 58% of the ADR negative admissions. Eighty-five per cent of the ADRs were recognized as such and 19% of the ALS-positive ADRs were not recognized by the staff physicians. Conclusions: The routine implementation of ALS doubled the number of ADRs recognized by the physicians while patients were hospitalized in the medical ward. The use of the system appeared valid, simple and potentially cost-effective.

[1]  D. Kennedy,et al.  Monitoring of adverse drug events in hospitals. , 1991, JAMA.

[2]  T. Brennan,et al.  The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. , 1991, The New England journal of medicine.

[3]  R S Evans,et al.  Preventing Adverse Drug Events in Hospitalized Patients , 1994, The Annals of pharmacotherapy.

[4]  R M Gardner,et al.  Computerized medication monitoring system. , 1976, American journal of hospital pharmacy.

[5]  R M Gardner,et al.  Development of a computerized adverse drug event monitor. , 1991, Proceedings. Symposium on Computer Applications in Medical Care.

[6]  T H Grasela,et al.  Capability of hospital computer systems in performing drug-use evaluations and adverse drug event monitoring. , 1993, American journal of hospital pharmacy.

[7]  R S Evans,et al.  Computerized surveillance of adverse drug events in hospital patients* , 1991, Quality and Safety in Health Care.

[8]  D. Classen,et al.  The Computer-Based Patient Record: The Role of the Hospital Epidemiologist , 1995, Infection Control & Hospital Epidemiology.

[9]  G D Schiff,et al.  Using a computerized discharge summary data base check box for adverse drug reaction monitoring. , 1990, QRB. Quality review bulletin.

[10]  D. Greenblatt,et al.  A method for estimating the probability of adverse drug reactions , 1981, Clinical pharmacology and therapeutics.

[11]  Z. T. Grapes,et al.  Factors associated with preventable adverse drug reactions. , 1994, American journal of hospital pharmacy.

[12]  C. E. Myers,et al.  ASHP national survey of hospital-based pharmaceutical services--1992. , 1993, American journal of hospital pharmacy.

[13]  Morning report: a forum for reporting adverse drug reactions. , 1996, The Joint Commission journal on quality improvement.

[14]  J. Aronson,et al.  Adverse drug reactions in a hospital general medical unit meriting notification to the Committee on Safety of Medicines. , 1996, British journal of clinical pharmacology.

[15]  D. Bates,et al.  The Costs of Adverse Drug Events in Hospitalized Patients , 1997 .

[16]  A G Lipman,et al.  Comparative study of prospective surveillance and voluntary reporting in determining the incidence of adverse drug reactions. , 1977, American journal of hospital pharmacy.

[17]  D. Classen,et al.  Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. , 1997, JAMA.

[18]  T. Brennan,et al.  Physician Reporting Compared with Medical-Record Review to Identify Adverse Medical Events , 1993, Annals of Internal Medicine.

[19]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[20]  T. Prosser,et al.  Multidisciplinary adverse drug reaction surveillance program. , 1990, American journal of hospital pharmacy.

[21]  R Segal,et al.  Sensitivity and specificity of three methods of detecting adverse drug reactions. , 1988, American journal of hospital pharmacy.

[22]  N. Dickey,et al.  Systems analysis of adverse drug events. , 1996, JAMA.

[23]  K Irjala,et al.  Using computerized individual medication data to detect drug effects on clinical laboratory tests. , 1995, Scandinavian journal of clinical and laboratory investigation. Supplementum.