title: Reliability evaluation of the adapted national coordinating council medication error reporting and prevention (NCC MERP) index.
abstract: OBJECTIVE
  Adapted National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index criteria were used in a study undertaken to evaluate commercial computerized provider order entry (CPOE) system impact on community hospital medication errors. This article describes: (1) adaptation of the Index, (2) classification criteria and processes used to assess the adapted Index, and (3) inter-rater reliability results.
  
  
  METHODS
  A random sample of 130 (17%) of 2251 medication safety events (MSEs) were classified based on event type, that is, adverse drug event (ADE) or potential ADE (PADE); preventability, that is, 'yes' or 'no,' and outcome severity. Event outcome severity was categorized using adapted Index categories E-I (ADEs) and B-D (PADEs). Decision rules were used for rule-based classification, while an MSE Case Review Panel used judgment-based classification when decision rules did not apply. Inter-rater reliability for both classification approaches was assessed with kappa coefficients, percentage agreement, and confidence intervals (CI).
  
  
  RESULTS
  Level of agreement was substantial for both rule-based and judgment-based MSE classification for event type (6 = 0.70-0.90), preventability (6 = 0.67-0.82), and decision rule application (6 = 0.79). Rule-based agreement for ADE and PADE severity was almost perfect for discrete (6 = 0.83-0.84) and combined (6 = 0.87-0.90) Index categories. Judgment-based agreement was substantial for discrete (6 = 0.63-0.67) and combined (6 = 0.66-0.84) Index categories.
  
  
  CONCLUSIONS
  The adapted Index yielded substantial agreement for event type, preventability, and severity. Adaptation of the Index to support classification of non-preventable ADEs was an important improvement.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Rita A
authors.initials: RA
authors.lastname: Snyder
authors.forename: Jacob
authors.initials: J
authors.lastname: Abarca
authors.forename: Jane L
authors.initials: JL
authors.lastname: Meza
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: Albert
authors.initials: A
authors.lastname: Rizos
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D003625:Data Collection / Q000379:methods; D006286:Health Planning Councils / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014481:United States