Pharmacoeconomics and Safe Medication Use

of 2.5%–10% (e.g., a hospital with 10,000 admissions reporting 1000 ADEs would have a 10% ADE

reporting rate). ADE benchmarks are difficult to determine because of the many variables that affect the

reporting methods, such as the ADE definition used by the facility or the definition used by the reporter,

the number of clinical pharmacists available to report, the vigilance and emphasis of the reporting

systems, and the use of technology or reports to increase reporting.

Allergy data are always documented in the patient’s medical record and are required in the patient

profile. Preferably, the specific medication that caused the allergy, the type of reaction, and when the

allergy occurred should be documented.

Medicare & Medicaid Services program is meant to assist in adopting EHR technology, including

advanced data sharing and a focus on quality of care. In 2018, the term meaningful use was changed to

promoting interoperability.

A drug-induced allergy can be an ADR or an ADE, depending on severity.

It is paramount to report and document ADE data in the patient’s medical record for the same reason

as documenting allergy data to prevent recurrence with the same drug or a drug from the same or

similar drug class, and to mitigate risk when the same drug may need to be used again or to mitigate

risk when other medications that can cause the same adverse event are used.

If possible, a true allergy and an ADE/ADR should be differentiated between within the EHR.

ADR and ADE data should be recorded in the electronic medical record and maintained in the record

indefinitely.

For mild ADRs: When the same medication is prescribed, the CDS system can be set to alert

the prescriber, or the data can be retrievable for review but without prompting the clinician (e.g.,

lisinopril-induced hypotension).

For moderate ADRs: When the same drug is prescribed, the EHR, including the CDS system, can

be programmed to highlight or warn the prescriber or require a text response with an explanation

for its continued use.

For severe ADRs and ADEs: When the same drug is prescribed, the EHR, including the CDS

system, can be programmed to cause a hard stop and prevent the drug from being prescribed or a

hard stop requiring a prompt with an explanation for use (e.g., isoniazid-induced hepatotoxicity).

Methods of Medication Error and ADR or ADE Surveillance

ADEs can be detected prospectively and retrospectively.

Pharmacists may detect ADEs prospectively while on patient care daily rounds, or from

communication with patients while administering medication histories or transitions of care (e.g.,

ICU to step-down) or during discharge counseling.

An example of CDS is automated triggers used for prospective surveillance of events (i.e., before

an event has occurred). Pharmacists may also detect ADEs retrospectively through medical record

reviews or during medication histories or chart reviews (i.e., after an event has occurred, so limited

opportunity for intervention).

the potential for alert-driven interventions to cause “alert fatigue.”

No consensus definition exists for alert fatigue; however, it can be conceptualized as how increasing

the number of alerts may result in decreased attention to interacting with the alerts.

Given the lack of definition, it is difficult to measure alert fatigue. Potential metrics may include the

following:

Sensitivity, specificity, positive predictive value, and negative predictive value of alerts

ii.

Number of alerts overridden