Pharmacists versus Nonpharmacists in Adverse Drug Event Detection
Pharmacists versus Nonpharmacists in Adverse Drug Event Detection
Purpose: A systematic review and metaanalysis were conducted to determine if studies that included pharmacists as chart reviewers detected higher rates of adverse drug events (ADEs) than studies that included other health care professionals or hospital personnel as chart reviewers.
Methods: A systematic review and metaanalysis of studies using chart review as the method of detection of ADEs were conducted. Pooled estimates of the ADE rates were calculated using the inverse variance weight method. Meta-analysis was performed using a random effects model. Using the Mann-Whitney U test, weighted rates of studies in which pharmacists versus other clinicians were the chart reviewers were compared.
Results: Thirteen studies satisfied the inclusion criteria. Using random effects metaanalysis, the mean of the weighted incidence rate detected by pharmacists was 0.33 ADE per admission (95% confidence interval [CI], 0.17-0.50); the mean was 0.16 ADE per admission (95% CI, 0.11-0.22) with detection by nonpharmacists. Significant heterogeneity was present between studies in both groups. A significant difference (p = 0.003) existed between the ADE rate reported by pharmacists (median = 0.23; interquartile range [IQR], 0.18-0.44) and that of nonpharmacists (median = 0.12; IQR, 0.02-0.49). Although there is overwhelming evidence of statistical heterogeneity, the numbers pertaining to the ADE rates detected by the two groups were large enough to indicate significant differences. Despite the heterogeneity, there is strong evidence that pharmacist-led interventions based on chart review report a higher ADE rate among inpatients.
Conclusion: A review of the literature revealed that pharmacists make a salient contribution as manual chart reviewers in inpatient ADE interventions.
The World Health Organization (WHO), the Food and Drug Administration, and the Joint Commission on Accreditation of Healthcare Organizations have recognized the importance of establishing mechanisms for adverse drug event (ADE) surveillance in health care organizations. Hospitals are mandated to have ongoing drug surveillance programs in place in order to detect and evaluate the effects of drugs and to propagate safe, appropriate, and effective drug therapies.
Several methods of surveillance are used in the clinical setting to detect ADEs. Voluntary spontaneous reporting systems are commonly used, but reporting rates have been observed to be as low as 1.5%. Computer-assisted surveillance techniques have been successful in some hospitals. These techniques require sophisticated clinical information systems and often lack the ability to search through progress notes for textual signals, leaving a considerable amount of data unexplored. Manual chart review has resulted in high rates of detection with the ability to identify a greater number of ADEs than other methods. In addition, it offers the potential to extract implicit clinical information present in free-text documents, such as progress notes, nursing notes, and discharge summaries. Manual chart review is therefore considered the gold standard in ADE detection. Despite these advantages, chart review requires relatively large resource use and expense, thus limiting its use to research studies.
Pharmacists play an important role in ADE surveillance activities, including serving as chart reviewers for ADE detection. Previous reviews have explored the role of pharmacists in preventing ADEs in the inpatient setting, such as pharmacist participation on rounds and medication reconciliation. Pharmacists' training in therapeutics and comprehensive drug knowledge makes them an obvious choice for ADE surveillance. However, chart review is a resource-intensive process that takes pharmacists' time away from patient care activities. The allocation of pharmacists' time in chart review can be justified by determining whether pharmacists are capable of detecting a greater number of ADEs than other health care professionals, such as nurses and physicians, or nonclinical personnel who are engaged in ADE surveillance.
A systematic review was conducted, followed by a meta-analysis, of the literature to determine if studies that included pharmacists as chart reviewers detected higher rates of ADEs among inpatients than studies that included other health care professionals or hospital personnel as chart reviewers.
Abstract and Introduction
Abstract
Purpose: A systematic review and metaanalysis were conducted to determine if studies that included pharmacists as chart reviewers detected higher rates of adverse drug events (ADEs) than studies that included other health care professionals or hospital personnel as chart reviewers.
Methods: A systematic review and metaanalysis of studies using chart review as the method of detection of ADEs were conducted. Pooled estimates of the ADE rates were calculated using the inverse variance weight method. Meta-analysis was performed using a random effects model. Using the Mann-Whitney U test, weighted rates of studies in which pharmacists versus other clinicians were the chart reviewers were compared.
Results: Thirteen studies satisfied the inclusion criteria. Using random effects metaanalysis, the mean of the weighted incidence rate detected by pharmacists was 0.33 ADE per admission (95% confidence interval [CI], 0.17-0.50); the mean was 0.16 ADE per admission (95% CI, 0.11-0.22) with detection by nonpharmacists. Significant heterogeneity was present between studies in both groups. A significant difference (p = 0.003) existed between the ADE rate reported by pharmacists (median = 0.23; interquartile range [IQR], 0.18-0.44) and that of nonpharmacists (median = 0.12; IQR, 0.02-0.49). Although there is overwhelming evidence of statistical heterogeneity, the numbers pertaining to the ADE rates detected by the two groups were large enough to indicate significant differences. Despite the heterogeneity, there is strong evidence that pharmacist-led interventions based on chart review report a higher ADE rate among inpatients.
Conclusion: A review of the literature revealed that pharmacists make a salient contribution as manual chart reviewers in inpatient ADE interventions.
Introduction
The World Health Organization (WHO), the Food and Drug Administration, and the Joint Commission on Accreditation of Healthcare Organizations have recognized the importance of establishing mechanisms for adverse drug event (ADE) surveillance in health care organizations. Hospitals are mandated to have ongoing drug surveillance programs in place in order to detect and evaluate the effects of drugs and to propagate safe, appropriate, and effective drug therapies.
Several methods of surveillance are used in the clinical setting to detect ADEs. Voluntary spontaneous reporting systems are commonly used, but reporting rates have been observed to be as low as 1.5%. Computer-assisted surveillance techniques have been successful in some hospitals. These techniques require sophisticated clinical information systems and often lack the ability to search through progress notes for textual signals, leaving a considerable amount of data unexplored. Manual chart review has resulted in high rates of detection with the ability to identify a greater number of ADEs than other methods. In addition, it offers the potential to extract implicit clinical information present in free-text documents, such as progress notes, nursing notes, and discharge summaries. Manual chart review is therefore considered the gold standard in ADE detection. Despite these advantages, chart review requires relatively large resource use and expense, thus limiting its use to research studies.
Pharmacists play an important role in ADE surveillance activities, including serving as chart reviewers for ADE detection. Previous reviews have explored the role of pharmacists in preventing ADEs in the inpatient setting, such as pharmacist participation on rounds and medication reconciliation. Pharmacists' training in therapeutics and comprehensive drug knowledge makes them an obvious choice for ADE surveillance. However, chart review is a resource-intensive process that takes pharmacists' time away from patient care activities. The allocation of pharmacists' time in chart review can be justified by determining whether pharmacists are capable of detecting a greater number of ADEs than other health care professionals, such as nurses and physicians, or nonclinical personnel who are engaged in ADE surveillance.
A systematic review was conducted, followed by a meta-analysis, of the literature to determine if studies that included pharmacists as chart reviewers detected higher rates of ADEs among inpatients than studies that included other health care professionals or hospital personnel as chart reviewers.
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