Consensus list of signals to detect potential adverse drug reactions in nursing homes.
OBJECTIVE
To develop a consensus list of agreed-upon laboratory, pharmacy, and Minimum Data Set signals that a computer system can use in the nursing home to detect potential adverse drug reactions (ADRs).


METHODS
Literature search for potential ADR signals, followed by an internet-based, a two-round, modified Delphi survey.


METHODS
A nationally representative survey of experts in geriatrics.


METHODS
Panel of 13 physicians, 10 pharmacists, and 13 advanced practitioners.


METHODS
Mean score and 95% confidence interval (CI) for each of 80 signals rated on a 5-point Likert scale (5=strong agreement with likelihood of indicating potential ADRs). Consensus agreement indicated by a lower-limit 95% CI of 4.0 or greater.


RESULTS
Panelists reached consensus agreement on 40 signals: 15 laboratory and medication combinations, 12 medication concentrations, 10 antidotes, and three Resident Assessment Protocols (RAPs). Highest consensus scores (4.6, 95% CI=4.4-4.9 or 4.4-4.8) were for naloxone when taking opioid analgesics; phytonadione when taking warfarin; dextrose, glucagon, or liquid glucose when taking hypoglycemic agents; medication-induced hypoglycemia; supratherapeutic international normalized ratio when taking warfarin; and triggering the Falls RAP when taking certain medications.


CONCLUSIONS
A multidisciplinary expert panel was able to reach consensus agreement on a list of signals to detect potential ADRs in nursing home residents. The results of this study can be used to prioritize an initial list of signals to be included in paper- or computer-based methods for potential ADR detection.
Handler
Steven M
SM
Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. handler@pitt.edu
Hanlon
Joseph T
JT
Perera
Subashan
S
Roumani
Yazan F
YF
Nace
David A
DA
Fridsma
Douglas B
DB
Saul
Melissa I
MI
Castle
Nicholas G
NG
Studenski
Stephanie A
SA
D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D003936:Diagnosis, Computer-Assisted; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D016903:Drug Monitoring; D006306:Health Surveys; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D010348:Patient Care Team; D010599:Pharmacokinetics; D012985:Software Design