PREVENTING ADVERSE DRUG EVENTS IN HOSPITALIZED-PATIENTS

OBJECTIVE: To use computerized adverse drug event (ADE) surveillance t o help identify methods to reduce the number of ADEs in hospitalized p atients. DESIGN: Prospective study of 79 719 hospitalized patients dur ing a 44-month period. SETTING: LDS Hospital, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. INTERVENTION: Sequential study periods of at least one yea r each were compared. In the first period, data were collected but not reported to physicians, pharmacists, or nurses. In the subsequent stu dy periods, three interventions (computerized alerts of drug allergies , standardized antibiotic administration rates, and timely physician n otification of all ADEs) were made to reduce the number of type B (all ergic or idiosyncratic reactions) and severe ADEs. RESULTs: In the fir st study period, we identified 56 type B ADEs during 120 213 patient d ays. During two subsequent study periods that included alerts to physi cians of known drug allergies and standardized antibiotic administrati on rates, 8 type B events were identified during 113 237 patient days and 18 during 107 868 patient days, respectively (p<0.002). Early noti fication of physicians of all confirmed ADEs regardless of severity wa s associated with a significant reduction of ADEs classified as severe from 41 during 113 859 patient days in the first study period to 12 d uring 103 071 patient days and 15 during 108 320 patient days in two s ubsequent study periods, respectively (p<0.001). CONCLUSIONS: Prospect ive surveillance of computer-based medical records for known drug alle rgies and appropriate drug administration rates can reduce the number of type B ADEs. Early ADE detection and notification of physicians per mit drug and dosage changes that reduce the progression of mild and mo derate ADEs to more severe conditions.