Evaluation of an Automated Surveillance System Using Trigger Alerts to Prevent Adverse Drug Events in the Intensive Care Unit and General Ward
Evaluation of an Automated Surveillance System Using Trigger Alerts to Prevent Adverse Drug Events in the Intensive Care Unit and General Ward
复制标题
DOI：
10.1007/s40264-015-0272-1
复制
发表时间：
2015-03-01
期刊：
影响因子：
4.2
通讯作者：
Kane-Gill, Sandra L.
中科院分区：
文献类型：
--
作者：
DiPoto, John P.;Buckley, Mitchell S.;Kane-Gill, Sandra L.
重症监护室（ICU）中的不良事件可能与几种可能的原因相关，因此确定药物相关因果评估比普通病房患者更具挑战性。因此，假设自动触发警报在不同的患者护理环境中可能会有不同的表现。本研究的目的是比较的频率和类型的临床显着的自动触发警报在重症和普通病房的患者，以及评估警报的性能与药物相关的危险条件（DRHCs）。方法一项回顾性队列研究进行了成人ICU和普通病房的患者在三个机构（学术，社区和农村医院）的卫生系统。从一个集中数据库中获得了在两个非连续月份期间生成的自动触发警报。针对所有警报，评价了药剂师对警报的响应和处方者对建议的响应。具有临床意义的事件定义为需要药物治疗变更的可采取行动的干预措施，药剂师确定该干预措施对患者安全性是适当的，并且医生接受了药剂师的建议。计算被认为是DRHC的每个触发警报的阳性预测值（PPV）（即，结果在研究期间，在623名患者中总共产生了751个警报。药剂师分别对ICU和普通病房产生的39.8%和44.8%的警报进行了干预。总体而言，无论患者护理环境如何，医生接受率约为90%。因此，ICU和非ICU的临床显著警报数量分别为88.9和83.4%。两种情况下的药物治疗变化类型相似。识别DRHC警报的PPV为0.66在ICU和0.76在普通病房patients.Conclusions的数量和类型的临床显着的警报是相似的，无论患者人群，这表明警报可能是同样有益的ICU人群，尽管在药物相关的事件裁定的挑战。在这两种情况下，都存在提高警报性能的机会，因此需要制定质量改进计划，以衡量警报性能并进行改进。
Introduction Adverse events in the intensive care unit (ICU) may be associated with several possible causes, so determining a drug-related causal assessment is more challenging than in general ward patients. Therefore, the hypothesis was that automated trigger alerts may perform differently in various patient care settings. The purpose of this study was to compare the frequency and type of clinically significant automated trigger alerts in critically ill and general ward patients as well as evaluate the performance of alerts for drug-related hazardous conditions (DRHCs).Methods A retrospective cohort study was conducted in adult ICU and general ward patients at three institutions (academic, community, and rural hospital) in a health system. Automated trigger alerts generated during two nonconsecutive months were obtained from a centralized database. Pharmacist responses to alerts and prescriber response to recommendations were evaluated for all alerts. A clinical significant event was defined as an actionable intervention requiring drug therapy changes that the pharmacist determined to be appropriate for patient safety and where the physician accepted the pharmacist's recommendation. The positive predictive value (PPV) was calculated for each trigger alert considered a DRHC (i.e., abnormal laboratory values and suspected drug causes).Results A total of 751 alerts were generated in 623 patients during the study period. Pharmacists intervened on 39.8 and 44.8 % alerts generated in the ICU and general ward, respectively. Overall, the physician acceptance rate of approximately 90 % was comparable irrespective of patient care setting. Therefore, the number of clinically significant alerts was 88.9 and 83.4 % for the ICU and non-ICU, respectively. The types of drug therapy changes were similar between settings. The PPV of alerts identifying a DRHC was 0.66 in the ICU and 0.76 in general ward patients.Conclusions The number and type of clinically significant alerts were similar irrespective of patient population, suggesting that the alerts may be equally as beneficial in the ICU population, despite the challenges in drug-related event adjudication. An opportunity exists to improve the performance of alerts in both settings, so quality improvement programs for measuring alert performance and making refinements is needed.