Stephanie Gautron1, Jason Wentzell2, Salmaan Kanji3, Tiffany Nguyen2, Daniel M Kobewka4, Erika MacDonald5. 1. ,BScPharm, ACPR, was, at the time of this study, a pharmacy resident at The Ottawa Hospital, Ottawa, Ontario. She is now a Pharmacist with the Centre de santé Saint-Boniface, My Health Team, St Boniface/St Vital, Winnipeg, Manitoba. 2. ,BScPharm, ACPR, BCOP, is a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario. 3. ,BScPharm, ACPR, PharmD, is a Clinical Pharmacy Specialist with The Ottawa Hospital and an Associate Scientist with The Ottawa Hospital Research Institute, Ottawa, Ontario. 4. ,MD, FRCPC, MSc, is a Staff Physician with the Department of Medicine, The Ottawa Hospital; a Clinician Investigator with The Ottawa Hospital Research Institute; and an Assistant Professor with the University of Ottawa, Ottawa, Ontario. 5. ,BScPharm, ACPR, MSc, is the Professional Practice Coordinator and a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario.
Abstract
BACKGROUND: The Protecting Canadians from Unsafe Drugs Act will eventually require institutions to report all serious adverse drug reactions (ADRs), although the proposed regulations do not yet define what will need to be reported and by whom. Knowledge about the occurrence of serious ADRs in the hospital setting is needed to optimize the effectiveness of reporting and to determine the potential implications of mandatory reporting. OBJECTIVES: To quantify and characterize suspected serious ADRs in patients admitted to a general medicine service, to assess the likelihood of causality, and to determine inter-rater agreement for identification of ADRs and assessment of their likelihood. METHODS: This prospective observational study involved 60 consecutive patients admitted to a general medicine service at a tertiary care teaching centre starting on March 28, 2016. The primary outcome was the number of serious ADRs, defined by Health Canada as ADRs that result in hospital admission, congenital malformation, persistent or significant disability or incapacity, or death; that are life-threatening; or that require significant intervention to prevent one of these outcomes. Medical records were reviewed independently by pairs of pharmacists for serious ADRs, and the likelihood of causality was assessed using the World Health Organization-Uppsala Monitoring Centre system. Inter-rater agreement was calculated using the kappa score, and disagreements were resolved by discussion and consensus. RESULTS: Twenty-three serious ADRs occurred in the sample of 60 patients. The proportion of patients experiencing a serious ADR that contributed to the original hospital admission was 19/60 (32%, 95% confidence interval [CI] 20%-43%), and 4 patients (7%, 95% CI 0%-13%) experienced a serious ADR during their hospital stay. Inter-rater agreement for occurrence of serious ADRs was moderate (kappa 0.58, 95% CI 0.35-0.76). CONCLUSION: Reportable serious ADRs were common among patients admitted to a general medicine service. Canadian hospitals would face difficulties reporting all serious ADRs because of the frequency of their occurrence and the subjectivity of their identification.
BACKGROUND: The Protecting Canadians from Unsafe Drugs Act will eventually require institutions to report all serious adverse drug reactions (ADRs), although the proposed regulations do not yet define what will need to be reported and by whom. Knowledge about the occurrence of serious ADRs in the hospital setting is needed to optimize the effectiveness of reporting and to determine the potential implications of mandatory reporting. OBJECTIVES: To quantify and characterize suspected serious ADRs in patients admitted to a general medicine service, to assess the likelihood of causality, and to determine inter-rater agreement for identification of ADRs and assessment of their likelihood. METHODS: This prospective observational study involved 60 consecutive patients admitted to a general medicine service at a tertiary care teaching centre starting on March 28, 2016. The primary outcome was the number of serious ADRs, defined by Health Canada as ADRs that result in hospital admission, congenital malformation, persistent or significant disability or incapacity, or death; that are life-threatening; or that require significant intervention to prevent one of these outcomes. Medical records were reviewed independently by pairs of pharmacists for serious ADRs, and the likelihood of causality was assessed using the World Health Organization-Uppsala Monitoring Centre system. Inter-rater agreement was calculated using the kappa score, and disagreements were resolved by discussion and consensus. RESULTS: Twenty-three serious ADRs occurred in the sample of 60 patients. The proportion of patients experiencing a serious ADR that contributed to the original hospital admission was 19/60 (32%, 95% confidence interval [CI] 20%-43%), and 4 patients (7%, 95% CI 0%-13%) experienced a serious ADR during their hospital stay. Inter-rater agreement for occurrence of serious ADRs was moderate (kappa 0.58, 95% CI 0.35-0.76). CONCLUSION: Reportable serious ADRs were common among patients admitted to a general medicine service. Canadian hospitals would face difficulties reporting all serious ADRs because of the frequency of their occurrence and the subjectivity of their identification.
Entities:
Keywords:
adverse drug reaction reporting; adverse drug reactions; hospital pharmacy; postmarket surveillance
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