Patient Safety and Quality

Voluntary reporting and computerized surveillance work best together to identify adverse drug events

Adverse drug events (ADEs) remain a major focus for detection and prevention in health care organizations. According to the Institute of Medicine (IOM), more than 1.5 million preventable ADEs occur each year in the United States. A new study finds that combining voluntary reporting with a computerized surveillance system offers a complementary and synergistic approach to detecting and preventing ADEs. Each ADE detection system has its own distinct advantages, note the Duke University researchers. Voluntary reporting is effective at identifying medication errors resulting from system failures related to administration, transcription, orders, and omission. Computerized surveillance delivers more quantitative data by estimating actual rates of ADEs.

The researchers evaluated all ADEs identified in adult inpatients at Duke University Hospital during a 7-month period. Computerized surveillance detected 710 ADEs, resulting in a rate of 6.93 events per 1,000 patient days. Voluntary reporting identified 205 ADEs for a rate of 1.96 events per 1,000 patient days.

Among high-risk drug categories, antidiabetic agents caused the most ADEs detected by computerized surveillance (68.2 percent), followed by anticoagulants (17 percent), and narcotics and benzodiazepines (12 percent). Voluntary reporting revealed that the largest event categories (where failure points were identified) were ordering (20.5 percent), administration (17.1 percent), monitoring (14.1 percent), and omissions (13.7 percent). Both detection systems found the postanesthesia care unit (PACU) to have the greatest rate of ADEs among nursing station units. Intensive care had almost a twofold higher rate of ADEs overall compared with general care.

According to the authors, there is very little overlap between voluntary reporting and computerized surveillance. Each system detects a different profile of ADEs. Therefore, hospitals need to implement both approaches combined into a comprehensive detection program. Computerized surveillance outperforms voluntary reporting when it comes to detecting ADEs in hospitalized adults. However, the two are complementary and work together synergistically.

The study was supported by the Agency for Healthcare Research and Quality (HS14882).

See "A multifaceted approach to safety: The synergistic detection of adverse drug events in adult inpatients," by Jeffrey Ferranti, M.D., M.S., Monica M. Horvath, Ph.D., Heidi Cozart, R.Ph., and others, in the September 2008 Journal of Patient Safety 4(3), pp. 184-190.

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