A COMPUTER ALERT SYSTEM TO PREVENT INJURY FROM ADVERSE DRUG EVENTS - DEVELOPMENT AND EVALUATION IN A COMMUNITY TEACHING HOSPITAL

Context.-Adverse drug events (ADEs) are the most common type of iatrog enic injury occurring in hospitalized patients. Errors leading to ADEs are often due to restricted availability of information at the time o f physician order writing. Objectives.-To develop, implement, and eval uate a computer alert system designed to correct errors that might lea d to ADEs and to detect ADEs before maximum injury occurs. Design.-Pro spective case series. Setting.-A 650-bed community teaching hospital i n Phoenix, Ariz. Patients.-Consecutive sample of 9306 nonobstetrical a dult patients admitted during the last 6 months of 1997. Interventions .-Thirty-seven drug-specific ADEs were targeted. Our hospital informat ion system was programmed to generate alerts in clinical situations wi th increased risk for ADE-related injury. A clinical system was develo ped to ensure physician notification of alerts. Main Outcome Measures. -A true-positive alert was defined as one in which the physician wrote orders consistent with the alert recommendation after alert notificat ion. Results.-During the 6-month study period, the alert system fired 1116 times and 596 were true-positive alerts (positive predictive valu e of 53%). The alerts identified opportunities to prevent patient inju ry secondary to ADEs at a rate of 64 per 1000 admissions. A total of 2 65 (44%) of the 596 true-positive alerts were unrecognized by the phys ician prior to alert notification. Conclusions.-Clinicians can use hos pital information systems to detect opportunities to prevent patient i njury secondary to a broad range of ADEs.