Pharmacoeconomics and Safe Medication Use

iii.

Number of alerts inappropriately overridden

iv.

Patient harm associated with inappropriately overridden alerts

This fatigue is associated with an increased risk of preventable ADEs in a critically ill population.

in the ICU.

Retrospective incident voluntary reporting is an ethical obligation of all health care professionals.

Voluntary reporting is the primary source of event identification for most institutions; however,

events are grossly underreported.

Typically, safety pharmacists are responsible for aggregating these data. These aggregate reports

are reviewed by the ADE committee for the institution. Possible prevention methods are determined

by the committee. This is a retrospective evaluation because events are typically evaluated when

there is allotted time, which is often when the patient is discharged from the hospital. This can be a

prospective method if real-time evaluation is an option.

Trigger/tracer drugs

ADEs can be detected using a CDS system within an EHR for trigger or tracer drugs – these

terms are used synonymously. Trigger or tracer drugs are drugs that are routinely prescribed to

treat ADEs, such as antidotes, or physiologic antagonists or agents for gastric decontamination.

These triggers prompt a targeted medical record review. Box 2 provides examples.

ii.

The CDS system can be programmed with a list of tracer drugs so that when prescribers order

a tracer drug, they are asked whether the order is for an ADE and, if so, what type of ADE

occurred. The potential ADE can then be reported and managed by the clinical pharmacist.

iii.

One of the benefits of this system is that it captures ADEs that might not have been reported,

especially when a clinical pharmacist may not be present on the unit or on daily patient care

rounds, and it allows for more physician-reported ADEs.

Box 2. Examples of Medications Used as Triggers or Tracers to Aid in Reporting Adverse Drug Events

D50W = dextrose 50% in water.