Computerized Surveillance for Adverse Drug Events in a Pediatric Hospital
ABSTRACT There are limited data on adverse drug event rates in pediatrics. The authors describe the implementation and evaluation of an automated surveillance system modified to detect adverse drug events (ADEs) in pediatric patients. The authors constructed an automated surveillance system to screen admissions to a large pediatric hospital. Potential ADEs identified by the system were reviewed by medication safety pharmacists and a physician and scored for causality and severity. Over the 6 month study period, 6,889 study children were admitted to the hospital for a total of 40,250 patient-days. The ADE surveillance system generated 1226 alerts, which yielded 160 true ADEs. This represents a rate of 2.3 ADEs per 100 admissions or 4 per 1,000 patient-days. Medications most frequently implicated were diuretics, antibiotics, immunosuppressants, narcotics, and anticonvulsants. The composite positive predictive value of the ADE surveillance system was 13%. Automated surveillance can be an effective method for detecting ADEs in hospitalized children.
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ABSTRACT: The authors report on the managerial and logistical details of deploying a computerized adverse drug event surveillance system that was at first a grant-funded research project and ultimately was changed to a sustained safety-monitoring application serving 3 different hospitals. Surveillance was deployed in 3 phases to 2 community-based hospitals and an academic medical center. A logic-based rules engine surveyed electronic records for laboratory, medication, and demographic information indicative of safety concerns. Potential adverse events triggered manual chart review by pharmacists to verify patient harm. During Phase 1, the research team created trigger rules for each hospital. In Phase 2, the trigger review was transitioned to hospital personnel and rule sets were reshaped for specific hospital needs. In Phase 3, surveillance was integrated into daily work flows and organizational balanced scorecards where it was accepted as a quantitative measure of medication safety performance. Computerized surveillance helps detect potentially harmful events regardless of hospital size. Active leadership, change-tolerant culture, and hospital pharmacy practice models significantly impact successful adoption. Entrenched cultural issues impeded sustainability at the academic center but not at the 2 community hospitals. Tailoring surveillance to the needs of different inpatient settings is crucial to developing a sustainable model.Quality management in health care 01/2010; 19(4):282-91. DOI:10.1097/QMH.0b013e3181fa0680
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ABSTRACT: Aggregation of adverse drug event data has evolved in the last decade. Several approaches are available to augment the standard voluntary incident reporting system. Most of these methods are applicable to nonmedication adverse events as well. To identify appropriately system trends as well as process failures, intensive care units should participate in various collection methods. Several different methods are available for robust adverse drug event data collection, such as target chart review, nontargeted chart review, and direct observation. As the various methods usually capture different types of events, employing more than one technique will improve the assessment of intensive care unit care. Some of these surveillance methods offer real-time or near real-time identification of adverse drug events and potentially afford the practitioner time for intervention. Continued development of adverse drug event detection will allow for further quality improvement efforts and preventive strategies to be utilized.Critical care medicine 06/2010; 38(6 Suppl):S117-25. DOI:10.1097/CCM.0b013e3181dde2d9 · 6.15 Impact Factor
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ABSTRACT: Nowadays, patients usually take more than three drugs for diseases such as hypertension, diabetes, and dyslipidemia. Hence, nuclear medicine physicians should be very careful about the medication history of each patient and ensure that their medication will not cause false positive or false negative imaging results, because either condition will interfere with adequate treatment of the patient and result in a wrong diagnosis. The aim of the present paper is to develop an ontology-based medication search and alert system for scintiphotography of Chang Gung Memorial hospital at Kaohsiung. Composed of four sub-systems, including Medication History Collect Agent (MHCA), Medication History Search System (MHSS), Patient Medication Consultation System (PMCS), and Patient Medication Alert System (PMAS), this medication search and alert system for scintiphotography is expected to support decision making of nuclear medicine examination, improve accuracy of image reading, and offer detailed data for further research. The ultimate goal of this system is to ensure patient safety.Journal of Medical Systems 07/2010; 36(2):737-46. DOI:10.1007/s10916-010-9541-9 · 2.21 Impact Factor