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Culture Counts—Sustainable Inpatient Computerized Surveillance Across Duke University Health System

Cozart, Heidi RPh; Horvath, Monica M. PhD; Long, Andrea PharmD; Whitehurst, Julie PharmD, MPH; Eckstrand, Julie RPh; Ferranti, Jeffrey MD, MS

doi: 10.1097/QMH.0b013e3181fa0680
Original Article

Purpose: The authors report on the managerial and logistical details of deploying a computerized adverse drug event surveillance system that was at first a grant-funded research project and ultimately was changed to a sustained safety-monitoring application serving 3 different hospitals.

Methods: Surveillance was deployed in 3 phases to 2 community-based hospitals and an academic medical center. A logic-based rules engine surveyed electronic records for laboratory, medication, and demographic information indicative of safety concerns. Potential adverse events triggered manual chart review by pharmacists to verify patient harm.

Results: During Phase 1, the research team created trigger rules for each hospital. In Phase 2, the trigger review was transitioned to hospital personnel and rule sets were reshaped for specific hospital needs. In Phase 3, surveillance was integrated into daily work flows and organizational balanced scorecards where it was accepted as a quantitative measure of medication safety performance.

Discussion and Conclusion: Computerized surveillance helps detect potentially harmful events regardless of hospital size. Active leadership, change-tolerant culture, and hospital pharmacy practice models significantly impact successful adoption. Entrenched cultural issues impeded sustainability at the academic center but not at the 2 community hospitals. Tailoring surveillance to the needs of different inpatient settings is crucial to developing a sustainable model.

Duke Health Technology Solutions, Duke University Health System (Messrs Cozart, Long, and Ferranti, Dr Horvath, and Mss Whitehurst and Eckstrand), Department of Pediatrics, Duke University School of Medicine (Dr Ferranti), Durham, North Carolina.

Correspondence: Monica M. Horvath, PhD, Duke Health Technology Solutions, 2424 Erwin Rd, DUMC 2718, Durham, NC 27705 (

This study was supported by grant # 5UC1HS014882–03 from the Agency for Health care Research and Quality, US Department of Health & Human Services.

©2010Lippincott Williams & Wilkins, Inc.