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. 2009 Apr;15(2):266-75.
doi: 10.1111/j.1365-2753.2008.00992.x.

Understanding pharmacist decision making for adverse drug event (ADE) detection

Shobha Phansalkar  1 , Jennifer M Hoffman, John F Hurdle, Vimla L Patel
Affiliations

Understanding pharmacist decision making for adverse drug event (ADE) detection

Shobha Phansalkar et al. J Eval Clin Pract. 2009 Apr.

Abstract

Rationale, aims and objective: Manual chart review is an effective but expensive method for adverse drug event (ADE) detection. Building an expert system capable of mimicking the human expert's decision pathway, to deduce the occurrence of an ADE, can improve efficiency and lower cost. As a first step to build such an expert system, this study explores pharmacist's decision-making processes for ADE detection.

Methods: Think-aloud procedures were used to elicit verbalizations as pharmacists read through ADE case scenarios. Two types of information were extracted, firstly pharmacists' decision-making strategies regarding ADEs and secondly information regarding pharmacists' unmet information needs for ADE detection. Verbal protocols were recorded and analysed qualitatively to extract ADE information signals. Inter-reviewer agreement for classification of ADE information signals was calculated using Cohen's kappa.

Results: We extracted a total of 110 information signals, of which 73% consisted of information that was interpreted by the pharmacists from the case scenario and only about half (53%, n = 32) of the information signals were considered relevant for the detection of the ADEs. Excellent reliability was demonstrated between the reviewers for classifying signals. Fifty information signals regarding unmet information needs were extracted and grouped into themes based on the type of missing information.

Conclusions: Pharmacists used a forward reasoning approach to make implicit deductions and validate hypotheses about possible ADEs. Verbal protocols also indicated that pharmacists' unmet information needs occurred frequently. Developing alerting systems that meet pharmacists' needs adequately will enhance their ability to reduce preventable ADEs, thus improving patient safety.

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Figures

Figure 1
Figure 1
An excerpt from the case scenario for the ADE of somnolence
Figure 2
Figure 2
An excerpt from the focus group session where pharmacists discussed the case scenario of somnolence. Extracted phrases, related to ADE detection are demarcated in italics in the excerpt.
Figure 3
Figure 3
Distribution of signals for the four ADEs, across the categories of Notes, Laboratory results, Medications, Vital signs and Implicit information.
See this image and copyright information in PMC

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References

    1. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–964. - PubMed
    1. Fertleman M, Barnett N, Patel T. Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. Qual Saf Health Care. 2005;14(3):207–211. - PMC - PubMed
    1. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377–384. - PubMed
    1. Nickerson A, MacKinnon NJ, Roberts N, Saulnier L. Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service. Healthc Q. 2005;8(Spec No):65–72. - PubMed
    1. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;61(16):1689–1695. - PubMed

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