Preventing Adverse Drug Reactions

Adverse Drug Reactions are problematic in that they cause significant morbidity and mortality. Almost 95% of ADRs are Type A (predictable) reactions, and thus with quality improvement measures, ADRs can be avoided and prevented. [a]

Knowledge of causative factors and an increase in patient education may help prevent ADRs. Improvements in the documentation of allergic reactions (e.g., via computer tracking), development of tools to enhance compliance, and application of tools to improve prescribing and administration of drugs are other preventative approaches to ADRs.

In 1994, the ASHP, the American Medical Association (AMA), and the American Nurses Association (ANA) generated the following system of recommendations to prevent ADRs in health care systems:

1. Health care systems should establish processes in which prescribers enter medication orders directly into computer systems.

2. Health care systems should evaluate the use of machine-readable coding (e.g., bar coding) in their medication use processes.

3. Health care systems should develop better systems for monitoring and reporting adverse drug events.

4. Health care systems should use unit dose medication distribution and pharmacy-based intravenous medication admixture systems.

5. Health care systems should assign pharmacists to work in patient care areas in direct collaboration with prescribers and those administering medications.

6. Health care systems should approach medication errors as system failures and seek system solutions in preventing them.

7. Health care systems should ensure that medication orders are routinely reviewed by the pharmacist before first doses and should ensure that prescribers, pharmacists, nurses, and other workers seek resolution whenever there is any question of safety with respect to medication use. [b]

References:

[a]. Rawlins, M.D. Adverse reactions to drugs. Br. Med. J. 1981, 82, 974–976.
[b]. American society of health system pharmacists. Top-priority actions for preventing adverse drug events in hospitals: ‘‘Recommendations of an expert panel.’’ Am. J. Health-Syst. Pharm.1996, 53, 747–751.