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A Multifaceted Approach to Safety: The Synergistic Detection of Adverse Drug Events in Adult Inpatients

Ferranti, Jeffrey MD, MS; Horvath, Monica M. PhD§; Cozart, Heidi RPh§; Whitehurst, Julie PharmD, MPH§; Eckstrand, Julie RPh§; Pietrobon, Ricardo MD, PhD, MBA†‡; Rajgor, Dimple MSc; Ahmad, Asif MS, MBA§

doi: 10.1097/PTS.0b013e318184a9d5
Original Articles

Objectives: Adverse drug event (ADE) detection is a national priority. This study compares results from 2 ADE detection systems, voluntary reporting and computerized surveillance, at a large academic medical center. We analyze the medications most likely to cause harm, evaluate each systems' strengths, and propose a synergistic strategy for medication safety.

Methods: Adult, inpatient ADEs from a 7-month period were evaluated and scored using a standardized methodology. ADEs per 1,000 patient days were calculated.

Results: Surveillance detected 710 ADEs (6.93/1000 patient days), whereas voluntary reporting identified 205 ADEs (1.96/1000 patient days). For each major drug category (anticoagulants, hypoglycemia, narcotics and benzodiazepines, and miscellaneous), surveillance and voluntary reporting detected significantly different event rates (P < 0.001). Most surveillance events were hypoglycemia-related (68.2%, 4.72/1000 patient days), whereas most voluntarily-reported events were in the miscellaneous category (49.8%, 0.98/1000 patient days). The 2 systems detected statistically different ADE rates when stratified by nursing station. Of all unique ADEs (875), only 40 (5.6%) were common between the systems.

Conclusions: This study analyzes the results of 2 ADE detection systems used in daily hospital operations as well as a health system scorecard. Our aggregate analysis underscores the synergistic nature of these approaches. Although surveillance provides quantitative data to estimate the actual rate of ADEs, voluntary reporting contributes qualitative evidence to prompt future surveillance rule development and identify areas of emerging risk. In isolation, each system paints a partial picture, but together, they amplify our understanding of patient safety.

From the *Department of Pediatrics, †Department of Surgery, and ‡Center for Excellence in Surgical Outcomes, Duke University School of Medicine; and §Duke Health Technology Solutions, Duke University Health System, Durham, NC.

This study was supported by grant #5UC1HS014882-03 from the Agency for Healthcare Research and Quality, National Institute of Health.

The authors do not have any competing or conflicting financial interest.

Correspondence: Monica M. Horvath, PhD, Duke Health Technology Solutions, 2424 Erwin Rd, DUMC 2718, Durham, NC 27705 (e-mail: monica.horvath@duke.edu).

© 2008 Lippincott Williams & Wilkins, Inc.