Adverse drug event detection in a community hospital utilising computerised medication and laboratory data.
OBJECTIVE
Computerised monitors can detect and, with clinical intervention, often prevent or ameliorate adverse drug events (ADEs). We evaluated whether a computer-based alerting system was useful in a community hospital setting.


METHODS
We evaluated 6 months of retrospectively collected medication and laboratory data from a 140-bed community hospital, and applied the rules from a computerised knowledge base to determine if the resulting alerts might have allowed a clinician to prevent or lessen harm related to medication toxicity. We randomly selected 11% (n = 58, of which 56 were available) of charts deemed to be high- or critical-priority alerts, based on the likelihood of the alerts being associated with injury, to determine the frequencies of ADEs and preventable ADEs.


RESULTS
In 6 months, there were 8829 activations of the rule set, generating a total of 3547 alerts. Of these, 528 were of high or critical priority, 664 were of medium priority and 2355 were of low priority. Chart review among the sample (56 charts) of high- or critical-priority alerts found five non-preventable and two preventable ADEs, suggesting that among the total high- or critical-priority alerts alone, there would be approximately 94 non-preventable ADEs and 37 preventable ADEs annually in this hospital that could be detected using this method.


CONCLUSIONS
Computer-based rules engines have the potential to identify and, with clinical intervention, mitigate preventable ADEs, and implementation is feasible in community hospitals without an advanced information technology application.
Seger
Andrew C
AC
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. ASEGER@PARTNERS.ORG
Jha
Ashish K
AK
Bates
David W
DW
D016907:Adverse Drug Reaction Reporting Systems; D002984:Clinical Laboratory Information Systems; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical; D006744:Hospital Bed Capacity, 100 to 299; D006751:Hospital Information Systems; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D016347:Medical Records Systems, Computerized; D012189:Retrospective Studies; D017751:Safety Management