Computerized surveillance of opioid-related adverse drug events in perioperative care: a cross-sectional study
Open Access
- 11 August 2009
- journal article
- Published by Springer Science and Business Media LLC in Patient Safety in Surgery
- Vol. 3 (1), 18
- https://doi.org/10.1186/1754-9493-3-18
Abstract
Background Given the complexity of surgical care, perioperative patients are at high risk of opioid-related adverse drug events. Existing methods of detection, such as trigger tools and manual chart review, are time-intensive which makes sustainability challenging. Using strategic rule design, computerized surveillance may be an efficient, pharmacist-driven model for event detection that leverages existing staff resources. Methods Computerized adverse drug event surveillance uses a logic-based rules engine to identify potential adverse drug events or evolving unsafe clinical conditions. We extended an inpatient rule (administration of naloxone) to detect opioid-related oversedation and respiratory depression to perioperative care at a large academic medical center. Our primary endpoint was the adverse drug event rate. For all patients with a naloxone alert, manual chart review was performed by a perioperative clinical pharmacist to assess patient harm. In patients with confirmed oversedation, other patient safety event databases were queried to determine if they could detect duplicate, prior, or subsequent opioid-related events. Results We identified 419 cases of perioperative naloxone administration. Of these, 101 were given postoperatively and 69 were confirmed as adverse drug events after chart review yielding a rate of 1.89 adverse drug events/1000 surgical encounters across both the inpatient and ambulatory settings. Our ability to detect inpatient opioid adverse drug events increased 22.7% by expanding surveillance into perioperative care. Analysis of historical surveillance data as well as a voluntary reporting database revealed that 11 of our perioperative patients had prior or subsequent harmful oversedation. Nine of these cases received intraoperative naloxone, and 2 had received naloxone in the post-anesthesia care unit. Pharmacist effort was approximately 3 hours per week to evaluate naloxone alerts and confirm adverse drug events. Conclusion A small investment of resources into a pharmacist-driven surveillance model gave great gains in organizational adverse drug event detection. The patients who experienced multiple events are particularly relevant to future studies seeking risk factors for opioid induced respiratory depression. Computerized surveillance is an efficient, impactful, and sustainable model for ongoing capture and analysis of these rare, but potentially serious events.Keywords
This publication has 20 references indexed in Scilit:
- The frustrating case of incident-reporting systemsQuality and Safety in Health Care, 2008
- Detection of adverse events in surgical patients using the Trigger Tool approachQuality and Safety in Health Care, 2008
- Reevaluating the Safety Profile of Pediatrics: A Comparison of Computerized Adverse Drug Event Surveillance and Voluntary Reporting in the Pediatric EnvironmentPEDIATRICS, 2008
- Cost implications of and potential adverse events prevented by interventions of a critical care pharmacistAmerican Journal of Health-System Pharmacy, 2007
- A Facilitated Survey Instrument Captures Significantly More Anesthesia Events Than Does Traditional Voluntary Event ReportingAnesthesiology, 2007
- Automated Surveillance for Adverse Drug Events at a Community Hospital and an Academic Medical CenterJournal of the American Medical Informatics Association, 2006
- Accuracy of adverse-drug-event reports collected using an automated dispensing systemAmerican Journal of Health-System Pharmacy, 2005
- Improving Safety with Information TechnologyThe New England Journal of Medicine, 2003
- Identifying Adverse Drug Events: Development of a Computer-based Monitor and Comparison with Chart Review and Stimulated Voluntary ReportJournal of the American Medical Informatics Association, 1998
- The Costs of Adverse Drug Events in Hospitalized PatientsJAMA, 1997