Increasing the detection of adverse drug events in pediatric patients

Patient safety has received unprecedented attention over the past decade. Some of that attention has been focused on the occurrence and prevention of harm from Adverse Drug Events (ADEs). Between 19 and 61 percent of ADEs are preventable. In order to prevent ADEs, they must first be detected. Several methods have been used to detect ADEs, including voluntary reporting, intensified surveillance, and computerized monitoring. Computerized monitoring has been shown to be complimentary to other methods in detecting ADEs. However, very little research has been completed on this method in pediatrics. Pediatric patients pose unique challenges and risks because of physiological immaturity, lack of testing and information on medications, availability of appropriate medication formulations and strengths, and incomplete cognitive and communication development. This study examined the modification and implementation of an adult computerized ADE monitoring tool at one pediatric medical center. It was implemented into the daily practice of pharmacy operations without increasing the pharmacy resources. Pharmacists printed daily reports containing alerts of possible ADEs. They investigated each of the alerts and noted whether an ADE occurred and how much time was needed to investigate. The main objective of this study was to increase the detection of ADEs in the pediatric population. iv Over the 12-week study, 181 ADEs were identified via the computerized monitoring tool. An additional 88 ADEs were voluntarily reported. Overall, this represented a rate of 6.6 ADEs per 100 admissions and 14.8 ADEs per 1,000 patient days. This result represented a significant increase in the detection of ADEs (p<0.0001) as compared to the same timeframe from the previous year. The computerized monitoring tool had a positive predictive value (PPV) of 4.8 percent. It took an average of 6.1 minutes to investigate alerts associated with an ADE, which was significantly higher than the time it took to investigate alerts not associated with an ADE (p<0.0001). Of the ADEs found with this tool, 10.5 percent were considered preventable. The use of a modified computerized ADE monitoring tool in the pediatric environment increased the overall detection of ADEs and warrants continued research.