Adverse Drug Reaction Surveillance: Practical Methods for Developing a Successful Monitoring Program

Josephine A. Vitillo, PharmD, BCPS, CGP


December 18, 2000

In This Article

How ADR Surveillance Can Improve Patient Quality of Care

  1. Allergy Documentation -- Reports of ADRs due to hypersensitivity reactions should result in an update of the patient's medical record and pharmacy profile to include additional medications that the patient is allergic to. When a patient suffers an allergic reaction in the hospital, mechanisms to update allergy history should exist to prevent the prescribing of the medication in the future. Seeger and colleagues[23] reported that preventable ADRs in hospitalized patients are likely to be dosage related or to occur among patients allergic to the specific agent. By informing the pharmacy department of all new allergic reactions and by updating the information in the pharmacy computer system, future ADRs can be easily prevented, saving the patient from harm.

  2. Policy and Procedure Modifications -- The systematic review of ADRs will identify opportunities to improve the medication-use process. Medications with a high potential for ADEs should be strictly monitored by means of specific policies and procedures. Drugs may be restricted to use in specific areas of the hospital or to specific qualified personnel as a means of preventing future ADEs. Widespread variability and use of a medication known to cause ADEs is careless and puts patients at risk. Active surveillance of medications by the pharmacy department is necessary to ensure that policies and procedures are adequate, updated, and/or modified as necessary. By standardizing protocols, variability is reduced, thereby decreasing the potential for ADEs.

  3. Educational Programs -- When ADR surveillance reveals that a lack of education of drug effects is resulting in ADRs, pharmacy-directed educational programs should be conducted. Prospective education on new medications prior to their availability on the formulary will help to prevent ADRs.

  4. Peripheral Brains -- Information to prevent ADEs can be provided on medication labels, electronic medication administration records (MARs), and electronic order entry warning screens. As the number of available medications expands, critical knowledge of differences among medications becomes more difficult to retain, and the risk of patients experiencing ADRs increases. Computerized physician order entry has been shown to reduce the rate of serious medication errors by more than half[24] and has been recommended by the IOM and the ASHP as a mechanism for preventing ADEs.[1,10]