Preventing adverse drug events in hospitalized patients.

OBJECTIVE: To use computerized adverse drug event (ADE) surveillance to help identify methods to reduce the number of ADEs in hospitalized patients.
DESIGN: Prospective study of 79,719 hospitalized patients during a 44-month period.
SETTING: LDS Hospital, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. INTERVENTION: Sequential study periods of at least one year each were compared. In the first period, data were collected but not reported to physicians, pharmacists, or nurses. In the subsequent study periods, three interventions (computerized alerts of drug allergies, standardized antibiotic administration rates, and timely physician notification of all ADEs) were made to reduce the number of type B (allergic or idiosyncratic reactions) and severe ADEs.
RESULTS: In the first study period, we identified 56 type B ADEs during 120,213 patient days. During two subsequent study periods that included alerts to physicians of known drug allergies and standardized antibiotic administration rates, 8 type B events were identified during 113,237 patient days and 18 during 107,868 patient days, respectively (p < 0.002). Early notification of physicians of all confirmed ADEs regardless of severity was associated with a significant reduction of ADEs classified as severe from 41 during 113,859 patient days in the first study period to 12 during 103,071 patient days and 15 during 108,320 patient days in two subsequent study periods, respectively (p < 0.001).
CONCLUSIONS: Prospective surveillance of computer-based medical records for known drug allergies and appropriate drug administration rates can reduce the number of type B ADEs. Early ADE detection and notification of physicians permit drug and dosage changes that reduce the progression of mild and moderate ADEs to more severe conditions.