title: Evaluation of an automated surveillance system using trigger alerts to prevent adverse drug events in the intensive care unit and general ward.
abstract: BACKGROUND
  Adverse events in the intensive care unit (ICU) may be associated with several possible causes, so determining a drug-related causal assessment is more challenging than in general ward patients. Therefore, the hypothesis was that automated trigger alerts may perform differently in various patient care settings. The purpose of this study was to compare the frequency and type of clinically significant automated trigger alerts in critically ill and general ward patients as well as evaluate the performance of alerts for drug-related hazardous conditions (DRHCs).
  
  
  METHODS
  A retrospective cohort study was conducted in adult ICU and general ward patients at three institutions (academic, community, and rural hospital) in a health system. Automated trigger alerts generated during two nonconsecutive months were obtained from a centralized database. Pharmacist responses to alerts and prescriber response to recommendations were evaluated for all alerts. A clinical significant event was defined as an actionable intervention requiring drug therapy changes that the pharmacist determined to be appropriate for patient safety and where the physician accepted the pharmacist's recommendation. The positive predictive value (PPV) was calculated for each trigger alert considered a DRHC (i.e., abnormal laboratory values and suspected drug causes).
  
  
  RESULTS
  A total of 751 alerts were generated in 623 patients during the study period. Pharmacists intervened on 39.8 and 44.8 % alerts generated in the ICU and general ward, respectively. Overall, the physician acceptance rate of approximately 90 % was comparable irrespective of patient care setting. Therefore, the number of clinically significant alerts was 88.9 and 83.4 % for the ICU and non-ICU, respectively. The types of drug therapy changes were similar between settings. The PPV of alerts identifying a DRHC was 0.66 in the ICU and 0.76 in general ward patients.
  
  
  CONCLUSIONS
  The number and type of clinically significant alerts were similar irrespective of patient population, suggesting that the alerts may be equally as beneficial in the ICU population, despite the challenges in drug-related event adjudication. An opportunity exists to improve the performance of alerts in both settings, so quality improvement programs for measuring alert performance and making refinements is needed.
authors.affiliation: Department of Pharmacy, Maricopa Integrated Health System, 2601 E. Roosevelt Street, Phoenix, AZ, 85008, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: DiPoto
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Buckley
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane-Gill
mesh_terms: D000328:Adult; D000368:Aged; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000517:prevention & control; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital / Q000592:standards; D008875:Middle Aged; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States