title: Signs and symptoms indicative of potential adverse drug reactions in homecare patients.
abstract: OBJECTIVE
  The purpose of this study was to determine whether homecare workers can detect signs and symptoms indicative of potential adverse drug reactions (ADRs) in homecare patients, using a standardized observation list.
  
  
  METHODS
  This observational study involved 115 patients cared for by 2 homecare organizations in The Netherlands between April 2011 and August 2011. During routine home visits, homecare workers filled out a standardized observation list of signs and symptoms indicative of potential ADRs, namely, gastrointestinal and other bleedings, electrolyte disturbances, renal and heart failure, digoxin intoxication, constipation, disturbances of diabetic control, and falls. Their observations were compared against the medications that the patients were using and their known side effects, by a panel of clinical pharmacology experts. Sensitivity, specificity, and positive and negative predicted values of the standardized observations were calculated.
  
  
  RESULTS
  In total, 234 signs and symptoms indicative of potential ADRs were observed by the homecare workers, 116 (49.6%) of which were considered drug related. More than one-half of the observed signs of gastrointestinal bleeding could be considered as drug related. Observed dizziness (64.1%) and drowsiness (53.3%) could be drug related in most cases, as could most cases (71.4%) of fainting spells (indicative of renal or heart failure). Seventeen of 20 observed falls could be drug related. The specificity of the standardized observation list was high, varying from 0.70 (confidence interval 0.62-0.77) to 0.97 (confidence interval 0.95-0.98).
  
  
  CONCLUSIONS
  Signs and symptoms indicative of potential ADRs recorded by homecare workers using a standardized observation list can aid in the early recognition of ADRs in homecare patients.
authors.affiliation: Research Center for Innovation in Healthcare, University of Applied Sciences Utrecht, Utrecht, The Netherlands. Electronic address: Carolien.sino@hu.nl.
authors.forename: Carolien G M
authors.initials: CG
authors.lastname: Sino
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Bouvy
authors.forename: Paul A F
authors.initials: PA
authors.lastname: Jansen
authors.forename: Ilona M B
authors.initials: IM
authors.lastname: Schop
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000139:chemically induced; D003288:Contusions / Q000139:chemically induced; D004244:Dizziness / Q000139:chemically induced; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis*; D042241:Early Diagnosis; D004844:Epistaxis / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006699:Home Care Services; D006801:Humans; D008297:Male; D008551:Melena / Q000139:chemically induced; D009426:Netherlands; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D013575:Syncope / Q000139:chemically induced
keywords: Early recognition; adverse drug reaction; homecare; observation