Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report.

摘要: Background: Adverse drug events (ADEs) are both common and costly. Most hospitals identify ADEs using spontaneous reporting, but this approach lacks sensitivity; chart review identifies more is expensive. Computer-based approaches to ADE identification appear promising, they have not been directly compared with widely used. Objectives: To develop a computer-based monitor, compare the rate type of found monitor those discovered by stimulated voluntary report. Design: Prospective cohort study in one tertiary-care hospital. Participants: All patients admitted nine medical surgical units hospital over an eight-month period. Main Outcome Measure: identified review, report. Methods: A monitoring program alerts, which were situations suggesting that might be present (e.g., order for antidote such as naloxone). trained reviewer then examined patients' records determine whether had occurred. The results strategy two other detection strategies: intensive report nurses pharmacists. strategies independent, reviewers blinded. Results: computer 2,620 275 determined ADEs. 398 ADEs, whereas detected 23. Of 617 at least method, 76 review. 45 percent; 65 report, 4 percent. likely classified “severe” than (51 versus 42 percent, p =.04). positive predictive value computer-generated alerts was 16 percent during first eight weeks study; rule modifications increased 23 final weeks. required 11 person-hours per week execute, 55 5. Conclusions: fewer did many report. overlap among different methods small, incidence may higher previously reported capture events. system represents efficient measuring frequency gauging effectiveness prevention programs.