Chapter 8. Computer Adverse Drug Event (ADE) Detection and Alerts

Background Adverse drug events (ADEs) occur in both inpatient and outpatient settings. Most institutions use spontaneous incident reporting to detect adverse events in general, and ADEs in particular. Spontaneous incident reporting relies exclusively on voluntary reports from nurses, pharmacists and physicians focused on direct patient care. However, spontaneous reporting is ineffective, identifying only one in 20 ADEs. Efforts to increase the frequency of spontaneous reporting have had only a minor impact. Several studies demonstrate the effectiveness of using computerized detection and alert systems (referred to as computer “monitors”) to detect ADEs. In 1991, Classen et al published information about a computerized ADE monitor that was programmed to identify signals—in effect mismatches of clinical information—that suggested the presence of an ADE. The signals included sudden medication stop orders, antidote ordering, and certain abnormal laboratory values. The computerized signals were then evaluated by a pharmacist who determined whether an ADE had occured. Based on the rules of this study, Jha et al developed a similar monitor that identified approximately half the ADEs identified by chart review, at much lower cost. Similarly, Bowman and Carlstedt used the Regenstrief Medical Record System to create a computerized inpatient ADE detection system. Compared to the “gold standard” of chart review, the monitor had 66% sensitivity and 61% specificity, with a positive predictive value of 0.34. Finally, one community hospital implemented an ADE monitor with triggers that were reviewed by pharmacists who then contacted physicians to make appropriate regimen changes. This study identified opportunities to prevent patient injury at a rate of 64/1000 admissions. These studies and others demonstrate the potential value of computer monitors, especially when linked to effective integrated information systems. While monitors are not yet widely used, they offer an efficient approach for monitoring the frequency of ADEs on an ongoing basis, and the Health Care Financing Administration is considering mandating them.