Adverse Drug Reactions, Nursing and Policy: A Narrative Review

Medicines' management is a priority in healthcare delivery, but weaknesses in the monitoring and management of Adverse Drug Reactions (ADRs) cause unplanned hospital admissions, financial burdens on healthcare systems, patient discomfort, morbidity, and mortality. This paper suggests policies and strategies that would help nurses minimise and manage ADRs to prescription medicines. The literature was searched for strategies to promote nurses' engagement with monitoring patients for potential ADRs. This narrative review opens the discussion by exploring the potential for nurse policy makers to address this hiatus in care. Recognition, amelioration and reporting of ADRs are important components of safe care, areas where nurses could make important contributions through collaboration in policy development, healthcare reform and enhanced nursing practice. Minimising ADRs necessitates paying sufficient attention to their recognition and prevention. Healthcare providers, particularly nurse leaders, need to commit to strategies to identify and address any adverse consequences of treatments, including ADRs: the axiom primum non nocere (first, do no harm) should be applied to all healthcare delivery. The application of structured nurse-led medicines' monitoring in practice depends on the collaboration of all healthcare professionals, co-ordinated by nurses. Incorporation of strategies to identify and ameliorate preventable ADRs into routine work will require the support of policy makers

DETECTING ADVERSE DRUG REACTIONS IN THE NURSING HOME SETTING USING A CLINICAL EVENT MONITOR

Adverse drug reactions (ADRs) are the most clinically significant and costly medication-related problems in nursing homes (NH), and are associated with an estimated 93,000 deaths a year and as much as $4 billion of excess healthcare expenditures. Current ADR detection and management strategies that rely on pharmacist retrospective chart reviews (i.e., usual care) are inadequate. Active medication monitoring systems, such as clinical event monitors, are recommended by many safety organizations as an alternative to detect and manage ADRs. These systems have been shown to be less expensive, faster, and identify ADRs not normally detected by clinicians in the hospital setting. The main research goal of this dissertation is to review the rationale for the development and subsequent evaluation of an active medication monitoring system to automate the detection of ADRs in the NH setting. This dissertation includes three parts and each part has its own emphasis and methodology centered on the main topic of better understanding of how to detect ADRs in the NH setting.The first paper describes a systematic review of pharmacy and laboratory signals used by clinical event monitors to detect ADRs in hospitalized adult patients. The second paper describes the development of a consensus list of agreed upon laboratory, pharmacy, and Minimum Data Set signals that can be used by a clinical event monitor to detect potential ADRs. The third paper describes the implementation and pharmacist evaluation of a clinical event monitor using the signals developed by consensus.The findings in the papers described will help us to better understand, design, and evaluate active medication monitoring systems to automate the detection of ADRs in the NH setting. Future research is needed to determine if NH patients managed by physicians who receive active medication monitoring alerts have more ADRs detected, have a faster ADR management response time, and result in more cost-savings from a societal perspective, compared to usual care

Assessing the Sensitivity of the Canadian Adverse Event Following Immunization Surveillance System ( CAEFISS)

Background: Vaccines are important to public health, but because of the way they are manufactured, their mechanism of action, and their indicated population, careful monitoring of their adverse events is necessary. Canada has a national surveillance system that collects reports on adverse events that may be associated with vaccine administration. Sensitivity is one of the tools used with surveillance systems to study the extent and characteristics of reporting of a surveillance system. To date, the sensitivity of the Canadian system has not been assessed. Purpose: To assess the sensitivity of the Canadian Adverse Event Following Immunization Surveillance System (CAEFISS). Methods: Based on specific adverse events following immunization (AEFI) and vaccines chosen for the study, a thorough literature search was completed to find the best source which identifies expected rates of AEFI. Studies used were assessed based on quality and sample size. The expected rates of AEFI, in combination with public health estimates of vaccine coverage rates, were used to estimate the expected number of reports. The reports provided the actual number of events used to calculate the sensitivity. Sensitivity was compared based on year of administration, age group, and type of AEFI. Results: The overall sensitivity of the CAEFISS varied from 1.0% to 136.6% for various AEFI for the years 1997 to 2008. For influenza the sensitivity was found to be 93.6% and 136.3% for GBS and anaphylaxis respectively. For DTaP, the rates were found to be 15.0%, 1.0%, and 21.2% for anaphylaxis, HHE, and seizures respectively, and for MMR the rates were 16.5%, 52.7%, and 12.7% in relation to anaphylaxis, thrombocytopenia, and seizures respectively. Conclusions: This is the first assessment of the sensitivity of the CAEFISS, and this study found that the system has reasonable ability to detect AEFI on a national level. CAEFISS had comparable senstivity to other vaccine reporting systems. Many of the AEFI had sensitivity values higher than the 5%-10% range traditionally seen in other passive surveillance systems related to adverse events. The greatest variation of sensitivity was seen between vaccines. Rarity and timing of the AEFI may also impact the sensitivity. Variation of sensitivity and the variation found in the sensitivity analysis lend to the further development and implementations of case definitions for rarer adverse events, especially anaphylaxis. Further research of other factors that impact reporting is necessary