Reducing adverse drug reactions

First DataBank Europe (FDBE) argues that clinical IT systems with effectively implemented clinical decision support can help to reduce ADRs and improve patient safety.

During 2005 a number of instances of Adverse Drug Reactions (ADRs) were reported in the UK national press - from 'Alert after everyday painkillers linked to danger of heart attack' (The Times, June 10th) to 'Prescription drugs linked to 15,000 deaths each year' (The Times, May 11th). Do these instances represent a growing challenge for clinicians?

Alarming statistics

A report published by the British Medical Journal in 2004 (compiled by researchers at the University of Liverpool) reported that over 10,000 Britons could be dying each year as a result of ADRs. The Department of Health’s report, 'An Organisation with a Memory', found that 10,000 hospital patients each year have serious adverse reactions to medicines and one fifth of clinical negligence litigation stems from hospital medication errors. Problems resulting from ADRs have a massive cost implication for the NHS.

ADRs are estimated to affect around seven per cent of patients or hospital admissions at an annual cost of about £380 million to the NHS (Department of Health 2003 – Our inheritance, Our future: Realising the potential of genetics in the NHS).

IT systems can provide effective clinical decision support

Without the appropriate IT systems in place, anticipating who will suffer from an ADR, when, and from what medication is difficult. Every time medication is prescribed and dispensed, clinicians, whether hospital doctors, GPs or pharmacists, carefully consider its suitability for the patient and potential adverse reactions. Modern clinical IT systems with integrated clinical decision support are designed to automatically alert the user to potential risk – they flag up drug interactions, allergies, contraindications, precautions, warnings and duplicate therapy. These resources are an essential element of clinical decision support for hard working clinicians.

This has already been proven by the Montagu Hospital in Doncaster where, through an electronic prescribing project, patient safety has demonstrably improved. JAC, a specialist developer of electronic prescribing and pharmacy systems, implemented a system that enables the hospital to perform clinical checks including interactions, allergies and duplicate therapy. Once the prescription has been entered at the bedside and confirmed by clinical pharmacists, the integration with the trusts’ pharmacy system enables the prescription to be immediately available at the hospital’s own pharmacy for dispensing. During a two-month audit on two acute medical wards in the first year of implementation at the Montagu, a total of 7,106 individual lines were prescribed. Almost 36 per cent of those lines prescribed were identified as clinical decision support warnings, including 1,081 potential drug interactions, 1,405 duplicate medications and 33 allergies – very real proof that technology can aid clinical decision making.

Too much information?

While decision alerts are critical to flag up an ADR, they can only be effective if they are timely and relevant. If clinicians are over-alerted to the potential hazards of each drug, it is possible that excessive information could lead to ‘alert blindness’. This can result in the recipient not identifying the most relevant and important details or, worse still, switching off the alerts altogether and putting patient lives at risk. This ultimately negates the value of the system. To better communicate warnings to the clinician, alerts need to be prioritised and focused, relating to frequency, severity and patient context.

Clinicians can certainly benefit from targeted and comprehensive clinical decision support as a tool for improving patient safety. FDBE is playing a key role in this, constantly developing its drug knowledge base and clinical decision support. This work has been recognised by NHS Connecting for Health, who has chosen FDBE to provide drug related clinical decision support for the NHS in England.