A comprehensive intervention for adverse drug reactions   identification and reporting in a Pediatric Emergency Department.
BACKGROUND
Physicians identify from 45.7 to 96.2 % of Adverse Drug Reactions (ADRs) in their patients, with under-reporting ranging from 6 to 100 %. In order to improve ADR reporting, several interventions have been evaluated in different studies, but not with regard to ADR identification. In addition, it is not known whether some patient characteristics might influence on ADR identification and reporting by physicians.


OBJECTIVE
(a) To assess the effectiveness of a comprehensive intervention directed to Emergency Department physicians and coordinated by a pharmacist in a tertiary care pediatric hospital on ADR identification and reporting. (b) To assess if some of the children’s characteristics might influence on ADR identification and reporting. Setting The Emergency Department of the Hospital Infantil de México “Federico Gómez”, which is a national pediatric institute of health in México.


METHODS
A Quasi-experimental, pre-post test trial was designed. During the intervention, the pharmacist gave talks on Pharmacovigilance and on the program for electronic capture of data, took part in patient visits, left reminders, improved accessibility to ADR report format and performed feedback activities. To classify and quantify correctly identified ADRs and ADRs reported to the Institutional Pharmacovigilance Center (IPC), 1136 clinical records were reviewed. The models were adjusted for patient variables.


METHODS
Total ADRs, ADRs correctly identified by physicians, ADRs reported to the IPC by physicians. Results Before the intervention, 97 % of ADRs were correctly identified and 6.1 % reported by physicians. During the intervention, 99.6 % were correctly identified and 41.2 % were reported, and after the intervention, 99.6 and 41.7 %, respectively. Identification during the intervention showed a sevenfold increase with regard to preintervention and was maintained post-intervention. ADR reporting during the intervention showed a 14-fold increase with regard to pre-intervention and was maintained during post-intervention.


CONCLUSIONS
Physicians do identify ADRs, but fail to report them. The intervention increased ADR correct identification and reporting. The effect was maintained after the intervention.
Olga
O
Morales Ríos
Luis
L
Jasso Gutiérrez
Juan O
JO
Talavera
Martha María
MM
Téllez-Rojo
Víctor
V
Olivar López
Juan
J
Garduño Espinosa
Onofre
O
Muñoz Hernández
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000367:Age Factors; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010595:Pharmacists; D060735:Pharmacovigilance; D010607:Pharmacy Service, Hospital; D010820:Physicians; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers