Can surveillance systems identify and avert adverse drug events? A prospective evaluation of a commercial application
Jha AK, Laguette J, Seger A, Bates DW. Can Surveillance Systems Identify and Avert Adverse Drug Events? A Prospective Evaluation of a Commercial Application. J Am Med Inform Assoc. 2008 Sep-Oct;15(5):647-53.
Question: Can a commercial computer based monitoring system (CBMS) identify and avoid adverse drug events (ADEs) and potential ADEs in a non-academic community hospital?
Background: ADEs contribute to morbidity and mortality, and the ultimate cost of medical care. Monitoring ADEs include self-reporting and chart review, but studies show them to be inadequate and expensive respectively. CBMS at academic institutions have been shown to detect a substantial proportion of ADEs. The study sought to determine if a commercially available CBM would identify and prevent ADEs in small and medium sized community hospitals without sophisticated information systems.
Methods and results: The prospective study screened 2,407 patients admitted during four months in 2004 in a 150 bed community hospital in Boston. Outcomes measured the presence of preventable ADEs and potential ADEs by generating alerts under the appropriate circumstances; not all alerts were reviewed by the pharmacist reviewer. Of the 266 alerts reviewed, 12% involved ADEs and 18% involved potential ADEs, with 30 considered serious. In a sampling of the 250 non-reviewed alerts, ADEs and potential ADEs were involved in 35% and 10% respectively. The annualized cost of monitoring using the CBMS was $80, 000, compared to $5000 per ADE in 2007.
Discussion: This evaluation using a commercially available ADE monitoring system was found to be efficient and effective in identifying a large number of ADEs and potential ADEs. The system can be deployed easily in a community hospital using 3 databases – laboratory results, pharmacy data, and demographic (ADT) data. The system also correctly identified errors in the hospital’s medication ordering system and highlighted a need for staff education to improve medication prescribing by identifying recurring ADEs associated with specific medications.
Comment: This study, like the retrospective study previously published by the authors, concludes that CBM can detect ADEs, at a reasonable cost. No other literature evaluating stand alone commercial systems was available for comparison; funding in part or whole was provided by the application developer. These detection rates compare favorably to other reports cited. For small to medium hospitals without sophisticated information systems, this may be an alternative to high cost integrated systems for the short term. ADE monitoring may assist in identifying areas of unknown risk in such areas as medication ordering systems or physician knowledge base.
--TBlehl 23:24, 22 October 2008 (CDT) Seger, A., Jha, A., and Bates, D. Adverse Drug Event Detection in a Community Hospital Utilising Computerised Medication and Laboratory Data. Drug Safety 2007 30(9):817-824.