title: Consensus list of signals to detect potential adverse drug reactions in nursing homes.
abstract: 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.
authors: Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. handler@pitt.edu
authors: Steven M
authors: SM
authors: Handler
authors: Joseph T
authors: JT
authors: Hanlon
authors: Subashan
authors: S
authors: Perera
authors: Yazan F
authors: YF
authors: Roumani
authors: David A
authors: DA
authors: Nace
authors: Douglas B
authors: DB
authors: Fridsma
authors: Melissa I
authors: MI
authors: Saul
authors: Nicholas G
authors: NG
authors: Castle
authors: Stephanie A
authors: SA
authors: Studenski
mesh_terms: 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