Improvement in the detection of adverse drug events by the use of electronic health and prescription records: an evaluation of two trigger tools.
OBJECTIVE
To test if two of the adverse event triggers proposed by the Institute of Healthcare Improvement can detect adverse drug events (ADEs) in a UK secondary care setting, using an electronic prescribing and health record system.


METHODS
In order to identify triggers for over-anticoagulation and potential opioid overdose and we undertook a retrospective review of electronic medical and prescription records from 54,244 hospital admissions over a 1-year period, alongside a review of medical incident reports. Once prescription data were linked to triggers and duplicates were removed, case note review eliminated the false positive ADEs. Additionally, we tested the use of an electronic algorithm for the International Normalized Ratio (INR) ≥6 trigger.


RESULTS
The INR ≥6 electronic trigger identified 46 potential ADEs and the naloxone electronic trigger identified 82 ADEs. Based on the available case note review, the INR ≥6 trigger had a positive predictive value (PPV) of 38 % (14/37) and the naloxone trigger had a PPV of 91 % (61/67). The electronic algorithm for the INR ≥6 trigger identified 12 ADEs, thus reducing the need of case note review. This was in comparison with one and two critical incidents reported in the trust medical incident reports system, which respectively related to over-coagulation with warfarin and over-sedation with opioid medication.


CONCLUSIONS
We have integrated automated and manual methods of detecting ADEs using previously defined triggers. Incorporating electronic triggers in already established electronic health records with prescription and laboratory test data can improve the detection of ADEs, and potentially lead to methods to avert them.
Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK. ugochi.nwulu@uhb.nhs.uk
Ugochi
U
Nwulu
Krishnarajah
K
Nirantharakumar
Rachel
R
Odesanya
Sarah E
SE
McDowell
Jamie J
JJ
Coleman
D016907:Adverse Drug Reaction Reporting Systems; D000701:Analgesics, Opioid / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D057286:Electronic Health Records; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019934:International Normalized Ratio; D008508:Medication Errors; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D006113:United Kingdom; D014859:Warfarin / Q000009:adverse effects
D000701:Analgesics, Opioid; D000925:Anticoagulants; D009292:Narcotic Antagonists; D009270:Naloxone; D014859:Warfarin