Use of tracking drugs for the search of intra-hospital adverse reactions: a pharmacovigilance study

Abstract

Objective:
To estimate the incidence of potential in-hospital adverse reactions with the use of alert drugs in a general hospital in southern Brazil. Method: Cross-sectional study, carried out in a hospital in southern Brazil. The electronic medical records (TASY®) of patients hospitalized between January and August 2020, who were prescribed one of the drugs earmarked for tracking adverse drug reactions, were evaluated: the drugs included flumazenil, fexofenadine hydrochloride, naloxone, promethazine, diphenhydramine and loperamide.

Results:
A total of 13,476 medical records were reviewed and 204 (1.5%) were included in the study in which tracker use was indicated in the management of adverse drug reactions. In this study a total of 18 different signs or symptoms were found in medical records, with pruritus/hyperemia/urticaria being the most reported symptoms (n = 76). Among the drug classes that caused most adverse drug reactions, opioids were the most mentioned (n = 44). It should be noted that in 49 medical records the information on which drug caused the adverse events was not reported. Regarding the cause of hospitalization of patients who used creening drugs, cancer was the most frequent (n = 37).

Conclusions:
This study indicates that the use of trackers can be a tool to estimate the occurrence of adverse drug reactions and to establish adverse events related to the use of medications, which should be reported to the pharmacovigilance service, with a view to patient safety.

Full text

Farmacia Hospitalaria
lEARLY ACCESS INDEXING l
Farmacia
HOSPITALARIA
Órgano o ficial de expre sión cientí fica de la Socie dad Española d e Farmacia Hospitalaria
Los artículos publicados en esta revista se distribuyen co n la licencia
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La revista Farmacia no cobra tasas por el envío de trabajos,
ni tampoco por la publicación de sus ar tículos.
Kely Corrêa Benedet Baesso et al.
ORIGINALS
Bilingual edition English/Spanish
Use of tracking drugs for the search of intra-hospital
adverse reactions: a pharmacovigilance study
Uso de fármacos alertantes para la detección
de reacciones adversas intrahospitalarias:
estudio de farmacovigilancia
Kely Corrêa Benedet Baesso1, Diego Zapelini do Nascimento2,
Alessandra de Sá Soares2, Fabiana Schuelter-Trevisol2,3
1Univers idade do Sul d e Santa Cat arina, Curs o de Medicina, Tu barão (Sant a Catarin a). Brazil. 2Programa de Pós-Graduação em Ciências da Saúde. Universidade
do Sul de Santa Catarina, Tubarão (Santa Cat arina). Brazil. 3Hospital Nossa Senhora da Conceição, Centro de Pesquisas Clínicas, Tubarão (Santa Catarina),
Brazil.
Author of correspondence
Fabiana Schuelter-Trevisol
Avda. José Acácio Moreira, 787
Bairro: Dehon
88704-900. Tubarão (Santa Catarina).
Brazil.
Email:
fastrevisol@gmail.com
Resumen
Objetivo: Estimar la incidencia de potenciales reacciones adversas
intrahospitalarias con el uso de prescripciones alertantes en un hospital
general del sur de Brasil.
Método: Estudio transversal, realizado en un hospital del sur de Brasil.
Se evaluaron las historias clínicas electrónicas (TASY®) de los pacientes
hospitalizados entre enero y agosto de 2020, a los que se les prescribió
uno de los medicamentos destinados al seguimiento de reacciones adver-
sas a medicamentos: los medicamentos incluían flumazenil, clorhidrato
de fexofenadina, naloxona, prometazina, difenhidramina y loperamida.
Resultados: Se revisaron 13.476 historias clínicas y se incluyeron 204 (1,5%)
en el estudio en el que se indicó el uso de prescripciones alertantes en el
manejo de reacciones adversas a medicamentos. En este estudio se encontró un
total de 18 signos o síntomas diferentes en las historias clínicas, siendo el prurito,
la hiperemia y la urticaria los síntomas más reportados (n = 76). Entre las clases
de fármacos que causaron la mayoría de las reacciones adversas a medica-
mentos, los opioides fueron los más mencionados (n = 44). Cabe señalar que
en 49 historias clínicas no se reportó la información sobre qué fármaco causó
los eventos adversos. En cuanto a la causa de hospitalización de los pacientes
que utilizaron prescripciones alertantes, el cáncer fue la más frecuente (n = 37).
Abstract
Objective: To estimate the incidence of potential in-hospital adverse
reactions with the use of alert drugs in a general hospital in southern
Brazil.
Method: Cross-sectional study, carried out in a hospital in southern
Brazil. The electronic medical records (TASY®) of patients hospitalized
between January and August 2020, who were prescribed one of the
drugs earmarked for tracking adverse drug reactions, were evaluated:
the drugs included flumazenil, fexofenadine hydrochloride, naloxone, pro-
methazine, diphenhydramine and loperamide.
Results: A total of 13,476 medical records were reviewed and 204
(1.5%) were included in the study in which tracker use was indicated in the
management of adverse drug reactions. In this study a total of 18 different
signs or symptoms were found in medical records, with pruritus/hypere-
mia/urticaria being the most reported symptoms (n = 76). Among the drug
classes that caused most adverse drug reactions, opioids were the most
mentioned (n = 44). It should be noted that in 49 medical records the
information on which drug caused the adverse events was not reported.
Regarding the cause of hospitalization of patients who used screening
drugs, cancer was the most frequent (n = 37).
Received 19 October 2021;
Accepted 17 December 2021.
Early Access date (04/26/2022).
DOI: 10.7399/fh.13039
KEYWORDS
Drug-Related Side Effects and Adverse Reactions;
Pharmacy Service, Hospital; Drug Utilization; Patient Safety;
Pharmacovigilance.
PALABRAS CLAVE
Efectos colaterales y reacciones adversas relacionadas
con medicamentos; Servicio de Farmacia, utilización de
medicamentos; Seguridad del paciente; Farmacovigilancia.
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Farmacia Hospitalaria
l EARLY ACCESS INDEXING lKely Corrêa Benedet Baesso et al.
Introduction
In the hospital setting, due to the complexity of clinical conditions, it
is common to use extensive pharmacotherapy to manage the signs and
symptoms presented by patients. In health institutions, the drug can have
different purposes, and can be used for treatment (cure or palliative), or
for prophylactic and diagnostic purposes1. In addition, it is common that
hospitalized patients have multiple comorbidities and be prescribed one or
more medications2,3.
Clinically important adverse drug events (ADE) can affect an average of
10% to 20% of hospitalized patients, and out of these, 7% can die2,3. Inten-
sive care units (ICU) usually have a higher number of ADE when compared
to wards, as they have more complex illnesses, take care of critically ill
patients and because of the number and type of medication administered.
The ICU, pediatric and geriatric sectors, polytherapy, patients with impaired
renal function and female gender increase the risk of drug-related ADE,
which corresponds to adverse drug reactions (ADR) and medication errors
(ME)4.
It is observed that ADRs are among the ten leading causes of death in
the United States and generate a great economic impact on the health
systems5. According to the patient’s age, ADRs can account for 0.16% to
15.7% of hospital admissions5,6. ADRs in the hospital setting are the cause of
numerous illnesses, disabilities and deaths6. In this way, the trackers proved
to be useful for detecting suspected ADR. It is extremely important that the
early detection of ADR and ME be carried out by a qualified and experien-
ced professional, especially for elderly patients, who compose the group
that experiences most these adverse events and, in most cases, make use
of different medications. Patients with ADR have a longer average length
of stay compared to patients without ADR and have furthermore severe
conditions in greater proportions than the other patients, which means a
burden for the health system and increased risks for the patient in the hos-
pital setting5,6.
ADRs correspond to approximately 7.0% of hospitalizations in health
systems, resulting in 840,000 cases/year, increasing health costs7, 8 .
Different methods and approaches are increasingly used to discover sus-
pected ADRs. Reporting such suspicions is considered an accessible and
cost-effective strategy. However, underreporting, low quality of reports
and difficulty in estimating frequencies and rates of suspected ADRs are
some of the health systems’ shortcomings9,10. In addition, other potential
obstacles to the notification of ADRs are pointed out, such as the short
time to notify, fear of the consequences of notification, lack of return of
notifications made by the health professional, uncertainties about what to
notify and the questions about the notifications may impact on positive
changes11.
Due to the characteristics of these ADEs, there is a need to monitor the
processes related to medications in the hospital setting12 and the develop-
ment of actions that can predict and prevent these ADEs. In this connection,
with patient safety as a priority, the use of alert drugs is one of the methods
that enables the early identification of ADR occurrence in patients6. The use
of these alert drugs acts as a “trigger” tool, showing great sensitivity and
specificity for the detection of ADRs when compared to existing measures
that assess the harm to the patient per se13. The “trigger” tool technique is
performed through the retrospective review of the prescriptions of all patients
using alert drugs, to identify possible ADRs related to patient care, or pros-
pectively from the identification of the alert drug when the prescription is
delivered to the pharmacist at the hospital pharmacy14.
The Institute for Healthcare Improvement (IHI) developed, from the review
of medical records, trackers with the objective of monitoring ADE in hospi-
tals15. Trackers are defined as data or clues in the patient’s medical record
that warns about potential harm6 and their presence allows directing the
investigation to determine the occurrence and measurement of ADE16.
There are some medications that are frequently used as trackers, such
as antidotes and antihistamines17. Antidotes are used to reverse or mini-
mize ADE conditions because they are safer or because they cause fewer
side effects and antihistamines are used to block the action of histamine,
which is an important amine in mediating anaphylactic reactions18,19. The
IHI listed 19 potential medications, previously tested and selected using
the retrospective medical record review technique, as ADE alert medi-
cines. Some examples include: diphenhydramine, vitamin K, flumazenil,
droperidol, ondansetron, promethazine, hydroxyzine, trimethobenzamide,
prochlorperazine, metoclopramide, naloxone, sodium polystyrene, cor-
ticosteroids, glucose 10-50%, glucose-insuline, norepinephrine. These
medications can be used to manage clinical situations such as hypoglyce-
mia, hematological and coagulation alterations, elevation of serum crea-
tinine, excessive sedation, lethargy, fall, rash, among other effects that
characterize ADRs20.
In addition to identifying ADRs, it is necessary to create prevention,
treatment and notification processes within the health institutions. Automating
these procedures, active search and follow-up, increasingly help detecting
events more than passive communications. In this framework, the analysis
of signs and symptoms and the identification of the use of alert drugs are
the safest practices, as they act as warning signs for adverse events and
are used in the hospital setting in a prospective and retrospective way in
intervention studies or in emergency studies21.
Given the above, this study aims to evaluate the incidence of potential
in-hospital ADRs by using alert drugs in a general hospital in southern Brazil
between January and June 2020.
Methods
A cross-sectional epidemiological study was carried out in a general
hospital in southern Santa Catarina. The study population consisted of medi-
cal records of patients hospitalized between January and June 2020, who
received a prescription for one of the drugs considered to be ADR trackers17.
The sample was selected by convenience, according to the alert drug use
as reported in the medical record during the study period. The convenience
sample was selected by the Clinical Pharmacy service of the hospital. For
each drug considered an alert drug, the review of the chart was performed
to investigate the ADR. The Clinical Pharmacy service does not take place
full-time in the hospital, and for this reason, the convenience sampling system
was adopted.
The hospital under study is located in Southern of Brazil. Its a general,
private and philantropic hospital, with 400 inpatient beds. The hospital
currently has 30 ICU beds and 10 neonatal ICU beds, being State refe-
rence for median and high complexity in general service. In addition, it has
a cancer care center. The population attended is 80% of patients Unified
Health Systems (SUS), the public health care of Brazil.
The medical records of patients of any age and of both genders who
were prescribed one of the following alert drugs were considered. The
drugs used included flumazenil (injectable), fexofenadine hydrochloride,
naloxone (injectable), promethazine (injectable), diphenhydramine or lope-
ramide. These drugs were selected because they are part of the hospital’s
drug standards. The medicines choosen as alert drugs for ADR, were selec-
ted based on scientific studies and defined by the Hospital Pharmacy Com-
mittee, as a pilot project study in the researched hospital.
To start data collection, the Information Technology (IT) Department was
asked to provide a report on the dispensing of these drugs by the Hospital
Pharmacy within the defined period. The report included the patient’s ser-
vice number, enabling access to the electronic medical record. With the
report at hand, the electronic medical chart was revised by the hospital cli-
nic pharmacist to define the case and collect the study variables of interest,
such as: gender, age group, length of stay, prescribed tracking drug, doses
Conclusiones: Este estudio indica que el uso de alertadores puede ser
una herramienta para estimar la incidencia de reacciones adversas a medi-
camentos y establecer eventos adversos relacionados con el uso de
medicamentos, los cuales deben ser reportados al servicio de farmacovigi-
lancia, con miras a la seguridad del paciente.
Conclusions: This study indicates that the use of trackers can be a tool
to estimate the occurrence of adverse drug reactions and to establish
adverse events related to the use of medications, which should be repor-
ted to the pharmacovigilance service, with a view to patient safety.
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Farmacia Hospitalaria
l EARLY ACCESS INDEXING lUse of tracking drugs for the search of intra-hospital adverse reactions: a pharmacovigilance study
of tracking drug used, patient’s clinical outcome, hospitalization diagnosis,
identified ADR and potential ADR-causing drug.
ADR was defined when the tracker was used in-hospital and a sign and
symptom resulting from a medication emerged, whether this medication was
indicated in the medical record or not. When the tracker was previously
used or its indication of use was determined without connection to ADR, the
case was excluded.
In the description of the data, absolute (n) and relative (%) frequencies
were used for qualitative variables and measures of central tendency and
dispersion for quantitative variables. The Microsoft Office Excel program
was used to prepare the database and charts and the SPSS v.21 software
(IBM, Armonk, New York, USA) for data analysis.
This study was approved by the Research Ethics Committee of the Univer-
sidade do Sul de Santa Catarina under opinion 4,135,024, dated July4,
2020.
Results
Between January and June 2020, 13,476 medical records of the diffe-
rent patients (some number of patients as medical charts) containing a pres-
cription for one of the six alert drugs selected in this study were evaluated.
Out of 13,476 medical records reviewed, 204 (1.5%) were included in the
study considering the use of the tracker associated with the management
of ADR (Table 1).
The hospitalization diagnoses of patients who used alert drugs in the
management of ADR were: cardiovascular disease (29), surgery (28), diges-
tive tract diseases (27), orthopedics (18), urinary tract diseases (14), neuro-
logy (11), pneumology (8), infections (7), chronic pain (6), dermatology (4),
intoxication (2), hematology (2), gynecology and obstetrics (2), endocrino-
logy (2), metabolic disease (2), burns (1), and fever of unknown origin (1).
Table 2 shows the demographic and clinical characteristics of patients
who used alert drugs.
It is noteworthy that the median age of respondents was 58.5 years
(P25: 42.0; P75: 67.0 years) and ranged between zero and 94 years of
age. The median length of stay was 7 days (P25: 2.0; P75: 15.0 days) and
ranged between zero and 125 days.
The evaluation of the types of ADR showed that 185 (91.6%) patients
had one symptom, 15 (7.4%) patients had two concomitant symptoms, and
two (1.0%) patients had three concomitant symptoms (data not shown in
the table).
Figure 1 shows a total of 18 different symptoms among 204 medical
records assessed. The category called pruritus/hyperemia/urticaria was the
most frequently mentioned (n = 76).
Figure 2 shows the drugs that potentially caused ADR. Among the drugs
classes with available information, opioids were the most mentioned (n =
44). It should be noted that in 49 medical records the information on which
drug caused the adverse event was not reported, which corresponds to
24% of all medications evaluated.
Table 1. Distribution of tracking medication information across medical records and drugs included in the survey.
January to June 2020
Triggers Medical records evaluated Medical records included Percentage of evaluated medical
records (%)
Naloxone 784 42 5.4
Flumazenil 774 25 3.2
Promethazine 3,968 62 1.6
Fexofenadine 2,325 34 1.4
Diphenhydramine 3,249 29 0.9
Loperamide 2,376 12 0.5
Total 13,476 204 1.5
Table 2. Distribution of demographic and clinical characteristics
of patients and drugs used as tracers in the management
of adverse drug reactions. January to June 2020
Variables n %
Gender
Male 106 52.0
Female 98 48.0
Age (years)
0-19 9 4.5
20-39 39 19.1
40-59 55 26.9
60-94 101 49.5
Length of hospitalization (days)
0-7 108 52.9
8-15 48 23.5
16-29 29 14.2
≥ 30 20 9.4
Triggers
Fexofenadine 34 16.7
Naloxone 42 20.6
Flumazenil 25 12.3
Promethazine 62 30.4
Loperamide 12 5.9
Diphenhydramine 29 14.2
Number of doses used
1 154 75.5
2-6 37 18.1
7-16 13 6.4
Outcome
Discharge 173 84.8
Death 24 11.8
Transfer to another clinical care 7 3.4
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Farmacia Hospitalaria
l EARLY ACCESS INDEXING lKely Corrêa Benedet Baesso et al.
Discussion
The incidence rate found in this study was 1.5% for adverse drug reac-
tions based on the use of alert drugs for drug reactions identification. ADR
incidence rates may vary according to the literature, depending on the
characteristics of the hospital and the strategies used to identify and search
for reactions. While Lima et al.21 also found 1.5% of ADR in the patients
evaluated, Nóbrega et al.22 identified a 12.9% rate.
The identification of ADRs is complex and can be characterized under
different aspects, such as type, severity, causality, among others. The pre-
sent study showed a total of 18 different adverse reactions in the 204eva-
luated medical records; the most common ADRs were those related to
dermatological aspects such as pruritus/hyperemia/urticaria, followed by
lowered level of consciousness/chest discomfort. All ADRs were described
in the electronic evolution history of the patient. Because they are visible and
acutely uncomfortable, the most commonly identified ADRs are those seen
on the skin and defined as allergic, characterized by itching, rash and skin
hyperemia5. A prospective review of medical records was carried out at a
tertiary care hospital in North India from August 2010-May 2011 conclu-
ding that the major risk factors associated with ADR included the number of
drugs, length of hospitalization and number of diagnosis23. Based on the
findings a rigorous study is recommended to determine the burden and iden-
tify the risk factors of ADR to target interventions23. In two medical units of
an Indian teaching hospital, the total cost of 154 ADRs in 140 patients was
Indian rupees (Rs). 1,490,803 with an average of Rs. 1,070 per patient.
The preventable cost for 57/154 ADR was Rs. 96,31024.
Most ADR identified cases affected the elderly, which suggests that
those cases are associated with age and greater vulnerability to ADE. In
the aging process, senescence reduces immunity, making the patient more
Figure 1. Description of cases evaluated according to the types of adverse reactions to identified drugs.
Adverse drug reactions*
010 20 30 40 50 60 70 80
*Some patients had more than one type of reaction.
Other
Dysphasia
Changes in heart beat
Hypotension
Rash
Diarrhea
Erythema/Hyperemia
Respiratory distress
Edema
Altered level of consciousness
Itching
Drug causing adverse reaction
Anticholinergic
Antihypertensive
Corticosteroid
Vaccine
Antiemetic
Anesthetic
Non-steroidal anti-inammatory drugs
Antiarrhythmic
Non-opioid analgesic
Benzodiazepine
Chemotheraphy
Antibiotic
Opioid
Unknown
010 20 30 40 50 60
Figure 2. Description of cases evaluated according to the types of drugs causing adverse reactions.
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Farmacia Hospitalaria
l EARLY ACCESS INDEXING lUse of tracking drugs for the search of intra-hospital adverse reactions: a pharmacovigilance study
susceptible to allergic processes, and reduces the vital functions affecting
the pharmacokinetics. Furthermore, physiological changes due to the aging
process affect different systems in these patients, such as a reduction in the
renal filtration rate, resulting in potential intoxication, lower liver metabolism
and pharmacodynamic particularities21. In line with the literature, Nagai
etal. explained that the elderly, for the most part, take several medications
(polytherapy) for having numerous simultaneous chronic diseases in a higher
percentage when compared to younger populations6. Polytherapy conside-
rably increases the risk of drug interactions and adverse effects since several
drugs, of different classes and pharmacological effects are being admi-
nistered concurrently, sometimes at the same time of the day22. Therefore,
reducing the amount of medication used by the patient should be a concern
of the healthcare team that allows for the reduction of drug interactions and
healthcare costs24. An alternative that allows the reduction of the number
of drugs administered is the use of non-pharmacological and preventative
measures against the occurrence of health problems25.
No matter as there is a growing increase in ADR in hospital institutions
and that research on this subject has been developing18, its complexity and
the scarcity of studies that address this issue, makes it difficult to find reliable
scientific evidence showing the dimensions of morbidities related to ADR26,
especially in Brazil. A systematic review and meta-analysis assessed the
frequency of adverse drug reactions in hospitalized patients and concluded
the wide variation in methodologies was one of the most important mode-
rators of heterogeneity. Therefore, it is important standardize methodologies
to reduce bias27
.
Neoplasms were the most frequent cause of hospitalization among
patients who were identified with ADR, followed by diseases of the car-
diovascular system. Patients with neoplastic diseases normally make use
of different antineoplastic drugs, sometimes in combinations, which can
cause different ADRs. According to Pérez-Ricart et al.28, in 2019, the main
therapeutic groups involved in adverse drug events were antineoplastic
agents (21.3%). In addition, other aspects may increase the chance of these
patients developing ADR, such as the use of polytherapy, affected immune
system20, and prescription of morphine that is used for the treatment of neo-
plastic pain, and which may be responsible for the increase in the onset of
ADR as it triggers histamine release26,28.
A study conducted in a tertiary hospital used medications as “triggers”
to search for ADRs, and it was found that analgesics and antibiotics were
the drug classes that caused the most ADRs in hospitalized patients21. These
findings corroborate the present study, in which hypnoanalgesics and anti-
biotics occupied first and second position, respectively, in the drug classes
identified as causing ADR28.
The drug alert chosen for this study were determined using standardized
medications at the hospital studied. The most frequently used tracker was
naloxone with 5.4% efficacy. This efficacy is measured by anesthesiologists
who reported that with the administration of naloxone, sedation was redu-
ced. Naloxone can be considered a good tracker because it is used as an
opioid antidote, neutralizing ADRs, narcotic intoxication and its side effects,
such as respiratory depression29.
Decreased level of consciousness, chest discomfort, and drowsiness
were the adverse events found as a result of the excessive use of prescri-
bed opioids and benzodiazepines. For this reason, naloxone once again
appeared as an effective tracker, as well as flumazenil, which can block the
central effects of substances that are active on benzodiazepine receptors30.
Flumazenil is classified as an antidote drug by Anatomical Therapeutic Che-
mical (ATC), and its prescription is indicated to reverse sedative action after
anesthesia, as well as in the treatment of acute overdose of benzodiaze-
pines6. In this context, it was observed that this tracker was 3.2% effective
and, together with naloxone, was considered the most effective tracker as
ADR indicator30.
The recording of information in connection with the use of medications is
essential to safely monitor the use of this technology, in addition to allowing
the identification of ADRs or ME, which may have underestimated the reac-
tions in the period under study. Among the limitations of the study, the use of
electronic medical records is highlighted, which did not justify or detail the
process of dispensing and administering the medication, only the prescrip-
tion. The evolutions assessed were not always complete to understand the
temporality of the events, in order to properly track the ADR and the drug
that caused such an event. The research hospital is in the process of imple-
menting the Clinical Pharmacy service, therefore Naranjo or Karch-Lasagna
were not used to identified ADR. This research became a pilot Project for
the needs of pharmacovigilance, and relevant area to Clinical Pharmacy. It
would be extremely necessary and useful to know which specific drugs are
the most frequently involved in each category that follows in table 1, howe-
ver, as this study is cross-sectional retrospective, it is impossible to accurately
identify which drugs are the most frequent to develop adverse reactions,
requiring the use of alert drugs. So, this is another limitation on this study.
Therefore, in this study, the search for adverse events caused by alert drugs
was performed. It is noteworthy that this strategy, although already used, is
being carried out for the first time in the service in question and may help
to monitor cases, helping the clinical pharmacy and patient safety service.
It is important that the healthcare team gets involved in developing phar-
macovigilance actions aimed at preventing and reducing ADRs, bringing
together different professionals and creating multidisciplinary teams that can
contribute both to patient safety and to reducing healthcare costs. The use
of trackers, in addition to estimating the incidence of ADR, allows us to verify
the profile of the most vulnerable patients and the therapeutic classes most
related to the events. However, further research is also suggested regarding
interventions and the minimization of ADRs, so that hospitals can adapt their
institutions and capacitate their health team involved.
Funding
No funding.
Acknowledgements
To the Clinical Pharmacy sector of the Hospital Nossa Senhora da
Conceição
Conflict of interest
No conflict of interest.
Contribution to the scientific literature
There are some drugs that are frequently used to reverse or mini-
mize adverse events because they are safer or cause fewer associated
effects. These medications can be used as trackers or triggers in iden-
tifying adverse drug reactions (ADR). The use of trackers to estimating
the prevalence of adverse drug reactions allows us to verify the profile
of the most vulnerable patients and the therapeutic classes most related
to the events. This is very important for patient safety during inpatient
healthcare. Considering that the incidence and magnitude of adverse
drug reactions in the hospital environment is unknown, the importance
of this study is evident, which aims to reduce risks to the patient through
the surveillance of adverse events. As results, it is possible to reduce
costs and time of hospital stay. The healthcare team can be involved in
developing pharmacovigilance actions aimed at preventing and redu-
cing adverse drug reactions, bringing together different professionals
and creating multidisciplinary teams that can contribute both to patient
safety and to reducing healthcare costs.
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