COMPUTERIZED SURVEILLANCE OF ADVERSE DRUG EVENTS IN HOSPITAL PATIENTS
COMPUTERIZED SURVEILLANCE OF ADVERSE DRUG EVENTS IN HOSPITAL PATIENTS
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DOI：
10.1001/jama.266.20.2847
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发表时间：
1991-11-27
影响因子：
120.7
通讯作者：
BURKE, JP
中科院分区：
文献类型：
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作者：
CLASSEN, DC;PESTOTNIK, SL;BURKE, JP
Objective. - 开发一种新的方法来提高医院患者中药物不良事件（ADE）的检测和表征。- 前瞻性研究的所有患者入院超过18个月的时间。设置。- LDS医院，盐湖，犹他州，一个520张病床的三级护理中心附属于医学院，盐湖犹他大学。- 我们开发了一种计算机化ADE监测仪，并使用集成的医院信息系统编写了计算机程序，以允许对医院患者中发生的潜在ADE进行多源检测。潜在ADE（自愿和自动）的信号包括突然停药命令、解毒剂订购和某些异常实验室值。每天生成这些来源的所有潜在ADE列表，药剂师审查所有可能发生ADE的患者的病历，以确定准确性和因果关系。经验证的ADE被分为轻度、中度或重度，以及A型（剂量依赖性或可预测）或B型（特异质或过敏）反应，并使用标准化评分方法进一步测量因果关系。- 检测到的ADE的数量和特征。- 在18个月内，我们监测了36653名住院患者。在648例患者中确定了731例经验证的ADE，701例ADE被定性为中度或重度，664例被归类为A型反应。在同一时期，使用传统检测方法仅识别出9种ADE。医生、药剂师和护士自愿报告了使用该自动系统检测到的731起ADE中的92起。其他631例ADE是从自动信号中检测到的，其中最常见的是盐酸苯海拉明和盐酸纳洛酮的使用、高血清药物水平、白细胞减少症以及植物甲萘醌和抗真菌药的使用。最常见的症状和体征是瘙痒、恶心和/或呕吐、皮疹和意识模糊-嗜睡。最常见的药物类别是镇痛药、抗感染药和心血管药物。- 我们认为，使用计算机化的医院信息系统筛查ADE为改善住院患者中这些事件的检测和表征提供了一种潜在的方法。
Objective. - To develop a new method to improve the detection and characterization of adverse drug events (ADEs) in hospital patients.Design. - Prospective study of all patients admitted to our hospital over an 18-month period.Setting. - LDS Hospital, Salt Lake City, Utah, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City.Patients. - We developed a computerized ADE monitor, and computer programs were written using an integrated hospital information system to allow for multiple source detection of potential ADEs occurring in hospital patients. Signals of potential ADEs, both voluntary and automated, included sudden medication stop orders, antidote ordering, and certain abnormal laboratory values. Each day, a list of all potential ADEs from these sources was generated, and a pharmacist reviewed the medical records of all patients with possible ADEs for accuracy and causality. Verified ADEs were characterized as mild, moderate, or severe and as type A (dose-dependent or predictable) or type B (idiosyncratic or allergic) reactions, and causality was further measured using a standardized scoring method.Outcome Measure. - The number and characterization of ADEs detected.Results. - Over 18 months, we monitored 36 653 hospitalized patients. There were 731 verified ADEs identified in 648 patients, 701 ADEs were characterized as moderate or severe, and 664 were classified as type A reactions. During this same period, only nine ADEs were identified using traditional detection methods. Physicians, pharmacists, and nurses voluntarily reported 92 of the 731 ADEs detected using this automated system. The other 631 ADEs were detected from automated signals, the most common of which were diphenhydramine hydrochloride and naloxone hydrochloride use, high serum drug levels, leukopenia, and the use of phytonadione and antidiarrheals. The most common symptoms and signs were pruritus, nausea and/or vomiting, rash, and confusion-lethargy. The most common drug classes involved were analgesics, anti-infectives, and cardiovascular agents.Conclusion. - We believe that screening for ADEs with a computerized hospital information system offers a potential method for improving the detection and characterization of these events in hospital patients.