Detection of adverse drug events using an electronic trigger tool
Detection of adverse drug events using an electronic trigger tool
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DOI：
10.2146/ajhp150481
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发表时间：
2016-09-01
影响因子：
2.7
通讯作者：
Weber, Robert J.
中科院分区：
文献类型：
--
作者：
Lim, Dennison;Melucci, Joe;Weber, Robert J.
目的。描述了用于检测药物不良事件（ADEs）的集成电子“触发工具”的实施和改进。在一家大型医疗中心进行了一项为期三个月的前瞻性研究，以测试和提高基于电子健康记录的工具的阳性预测价值（PPV），该工具用于检测与使用四种“触发药物”相关的ade：逆转剂氟马西尼、纳洛酮、植物二酮和鱼蛋白。在给成年患者使用触发性药物时，将电子信息传送给两名药剂师，他们近乎实时地（通常在同一天）审查病例，以检测实际或潜在的ade。在第一阶段的研究中，任何触发药物的使用都会产生警告信息；在随后的阶段，警报标准在临床标准和实验室数据的基础上被缩小，目标是完善触发工具的ppv结果。在为期三个月的研究期间，共审查了87种药物，检测到27种ade。第1、2、3期的PPV值分别为0.33、0.21、0.36。触发工具的总体PPV相对较低，主要归因于与植物二酮使用相关的假阳性触发信息（此类信息从第一阶段的35个减少到第三阶段的7个）。基于检测逆转剂氟马西尼、纳洛酮、植物二酮和鱼精蛋白使用情况的电子触发工具的评估和改进发现，在三个月的研究期间，总体PPV为0.31。
Purpose. Implementation and refinement of an integrated electronic "trigger tool" for detecting adverse drug events (ADEs) is described.Methods. A three-month prospective study was conducted at a large medical center to test and improve the positive predictive value (PPV) of an electronic health record-based tool for detecting ADEs associated with use of four "trigger drugs": the reversal agents flumazenil, naloxone, phytonadione, and protamine. On administration of a trigger drug to an adult patient, an electronic message was transmitted to two pharmacists, who reviewed cases in near real time (typically, on the same day) to detect actual or potential ADEs. In phase 1 of the study, any use of a trigger drug resulted in an alert message; in subsequent phases, the alerting criteria were narrowed on the basis of clinical criteria and laboratory data with the goal of refining the trigger tool's PPV.Results. A total of 87 drug administrations were reviewed during the three-month study period, with 27 ADEs detected. PPV values in phases 1, 2, and 3 were 0.33, 0.21, and 0.36, respectively. The relatively low overall PPV of the trigger tool was largely attributable to false-positive trigger messages associated with phytonadione use (such messages were reduced from 35 in phase 1 to 7 in phase 3).Conclusion. Evaluation and refinement of an electronic trigger tool based on detecting the use of the reversal agents flumazenil, naloxone, phytonadione, and protamine found an overall PPV of 0.31 during a three-month study period.