Abstract
Detection of adverse drug reactions (ADRs) in hospitals offers the chance to detect serious ADRs resulting in hospitalisation and ADRs occurring in hospitalised patients, i.e. patients with high comorbidity and receiving drugs that are administered only in hospitals. The most commonly applied methods involve stimulated spontaneous reporting of doctors and nurses, comprehensive collection by trained specialists and, more recently, computer-assisted approaches using routine data from hospital information systems. The different methods of ADR detection used result in different rates and types of ADRs and, consequently, in different drug classes being responsible for these ADRs. Another factor influencing the results of surveys is the interpretation of the term ADR, where some authors adhere to the strict definition of the World Health Organization and many others include intended and unintended poisoning as well as errors in prescribing and dispensing, thus referring to adverse drug events. Depending on the method used for screening of patients, a high number of possible ADRs and only few definite ADRs are found, or vice versa. These variations have to be taken into account when comparing the results of further analyses performed with these data. ADR rates and incidences in relation to the number of drugs prescribed or patients exposed have been calculated in only a few surveys and projects, and this interesting pharmacoepidemiological approach deserves further study. In addition, the pharmacoeconomic impact ofADRs, either resulting in hospitalisation or prolonging hospital stay, has been estimated using different approaches. However, a common standardised procedure for such calculations has not yet been defined. Although detection of ADRs in hospitals offers the opportunity to detect severe ADRs of newly approved drugs, these ADRs are still discovered by spontaneous reporting systems. The prospects offered by electronic hospital information systems as well as implementation of pharmacoepidemiological approaches increases the possibilities and the value of ADR detection in hospitals.
Similar content being viewed by others
References
Hurwitz N. Admissions to hospital due to drugs. BMJ 1969; 1: 539–40
Hurwitz N, Wade OL. Intensive hospital monitoring of adverse reactions to drugs. BMJ 1969; 1: 536–9
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. JAMA 1998; 279: 1200–7
Kvasz M, Allen E, Gordon MJ, et al. Adverse drug reactions in hospitalized patients: a critique of a meta-analysis [online]. Available from: URL: http://www.medscape.com/Medscape/GeneralMedicine/journal/2000/v02.n02/mgm0427.Kvasz [Accessed 2001 Oct 5]
Classen DC, Burke JP, Pestotnik SL, et al. Surveillance for quality assessment: IV. surveillance using a hospital information system. Infect Control Hosp Epidemiol 1991; 12: 239–44
Muehlberger N, Schneeweiss S, Hasford J. Adverse drug reaction monitoring — cost and benefit considerations part I: frequency of adverse drug reactions causing hospital admission. Pharmacoepidemiol Drug Saf 1997; 6(3 Suppl.): S71–7
Goettler M, Schneeweiss S, Hasford J. Adverse drug reaction monitoring — cost and benefit considerations part II: cost and preventability of adverse drug reactions leading to hospital admission. Pharmacoepidemiol Drug Saf 1997; 6(3 Suppl.): S79–90
Hallas J, Gram LF, Grodum E, et al. Drug related admissions to medical wards: a population based survey. Br J Clin Pharmacol 1992; 33: 61–8
Schneeweiss S, Göttler M, Hasford J, et al. First results from an intensified monitoring system to estimate drug-related hospital admissions. Br J Clin Pharmacol. Br J Clin Pharmacol 2001; 52: 196–200
Evans JMM, MacDonald TM. Record-linkage for pharmacovigilance in Scotland. Br J Clin Pharmacol 1999; 47: 105–10
Currie CJ, MacDonald TM. Use of routine healthcare data in safe and cost-effective drug use. Drug Saf 2000; 22: 97–102
Teweleit S, Kuschel U, Hippius M, et al. Manifestation und Präventionsmöglichkeiten unerwünschter Arzneimittelwirkungen (UAW) in der Pharmakotherapie von Herz-Kreislauferkrankungen. Med Klin 2001; 96: 442–50
Hayes JL, Evans JMM, Lipworth BP, et al. Potentially hazardous co-prescribing of β-adrenoceptor antagonists and agonists in the community. Br J Gen Pract 1996; 46: 423–5
Bates DW, Spell N, Cullen DC, et al. The costs of adverse drug events in hospitalized patients. JAMA 1997; 277: 307–11
Classen DC, Pestotnik SL, Evans RS, et al. Adverse drug events in hospitalized patients. JAMA 1997; 277: 301–6
van den Bemt PMLA, Egberts ACG, Lenderink AW, et al. Adverse drug events in hospitalised patients: a comparison of doctors, nurses and patients as sources of reports. Eur J Clin Pharmacol 1999; 55: 155–8
Mannesse CK, Derkx FHM, de Ridder MAJ, et al. Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study. BMJ 1997; 315: 1057–9
Moore N, Lecointre D, Noblet C, et al. Frequency and cost of serious adverse drug reactions in a department of general medicine.Br J Clin Pharmacol 1998; 45: 301–8
Martinez-Mir I, Garcia-Lopez M, Palop V, et al. A prospective study of adverse drug reactions as a cause of admission to a pediatric hospital. Br J Clin Pharmacol 1996; 42: 319–24
Francis GS. Cardiac complications in the intensive care unit. Clin Chest Med 1999; 20: 269–85
Classen DC, Pestotnik SL, Evans RS, et al. Computerized surveillance of adverse drug events in hospital patients. JAMA 1991; 266: 2847–51
Leape LL, Bates DW, Cullen DC, et al. System analysis of adverse drug events. JAMA 1995; 274: 35–43
Dormann H, Muth-Selbach U, Krebs S, et al. Incidence and costs of adverse drug reactions during hospitalisation. Drug Saf 2000; 2: 161–8
Azaz-Livshits T, Levy M, Sadan B, et al. Computerized surveillance of adverse drug reactions in hospital: pilot study. Br J Clin Pharmacol 1998; 45: 309–14
Leape L, Brennan T, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991; 324: 377–84
Tegeder I, Levy M, Muth-Selbach U, et al. Retrospective analysis of the frequency and recognition of adverse drug reactions by means of automatically recorded laboratory signals. Br J Clin Pharmacol 1999; 47: 557–64
Lau HS, Florax C, Porsius AJ, et al. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 2000; 49: 597–603
Bowman L, Carlstedt BC, Black CD. Incidence of adverse drug reactions in adult medical inpatients. Can J Hosp Pharm 1994; 47: 209–16
Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 1999; 282: 267–70
Roughead EE, Gilbert AL, Primrose JG, et al. Drug-related hospital admissions: a review of Australian studies published 1988 — 1996. Med J Aust 1998; 168: 405–8
Beard K. Adverse drug reactions as a cause of hospital admission in the aged. Drugs Aging 1992; 2: 356–67
Fattinger K, Roos M, Vergères P, et al. Epidemiology of drug exposure and adverse drug reactions in two Swiss departments of internal medicine. Br J Clin Pharmacol 2000; 49: 158–67
Thürmann PA, Hompesch BC. Influence of gender on pharmacokinetics and pharmacodynamics of drugs. Int J Clin Pharmacol Ther 1998; 36: 586–90
Imbs JL, Pouyanne P, Haramburu F, et al. Iatrogénie médicamenteuse: estimation de sa prévalence dans les hôpitaux publics français. Thérapie 1999; 54: 21–7
Pouyanne P, Haramburu F, Imbs JL, et al., for the French Pharmacovigilance Centres. Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. BMJ 2000; 320: 1036
Pryor TA, Gardner RM, Clayton PD, et al. The HELP system. J Med Syst 1983; 7: 87–102
Schmitt K, Windecker R, Steffen J, et al. Detection of adverse drug reactions by a computer-based generation of laboratory signals [abstract]. Br J Clin Pharmacol 2000 [Abstracts of CPT 2000]; 87: A331
World Health Organization. International drug monitoring: the role of the hospital. WHO Tech Rep Ser 1969; No. 425
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000; 356: 1255–9
Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. JAMA 1995; 274: 29–34
Bergman U, Wiholm BE. Drug-related problems causing admission to a medical clinic. Eur J Clin Pharmacol 1981; 20: 193–200
Rawlins MR. Clinical pharmacology: adverse reactions to drugs. BMJ 1981; 282: 974–6
Pirmohamed M, Breckenridge AM, Kitteringham NR, et al. Adverse drug reactions. BMJ 1998; 316: 1295-8
Naranjo S, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–45
Netting an important database [editorial]. Lancet 2001; 357: 649
Hallas J, Harvald B, Worm J, et al. Drug related hospital admissions. Eur J Clin Pharmacol 1993; 45: 199–203
Evans RS, Pestotnik SL, Classen DC, et al. Preventing adverse drug events in hospitalized patients. Ann Pharmacother 1994; 28: 523–7
Landis NT. ADE rate uncertain, reporting systems inadequate, GAO tells legislators. Am J Health Syst Pharm 2000; 57:515–23
Wood AJ. Thrombotic thrombocytopenic purpura and clopidogrel — a need for new approaches to drug safety. N Engl J Med 2000; 342: 1824–6
Bennett CL, Connors JM, Carwile JM, et al. Thrombotic thrombocytopenic purpura associated with clopidogrel. N Engl J Med 2000; 342: 1773–7
Moore N. The role of the clinical pharmacologist in the management of adverse drug reactions. Drug Saf 2001; 24: 1–7
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thürmann, P.A. Methods and Systems to Detect Adverse Drug Reactions in Hospitals. Drug-Safety 24, 961–968 (2001). https://doi.org/10.2165/00002018-200124130-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-200124130-00003