. 2018 Oct 26;131(1484):46-60.

Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Jerome Ng¹, Penny Andrew², Paul Muir³, Monique Greene⁴, Sabitha Mohan⁵, Jacqui Knight⁶, Phil Hider⁷, Peter Davis⁸, Mary Seddon⁹, Shane Scahill¹⁰, Jeff Harrison¹¹, Lifeng Zhou¹², Vanessa Selak¹³, Carlene Lawes¹⁴, Geetha Galgali¹⁵, Joanna Broad¹⁶, Marilyn Crawley¹⁷, Wynn Pevreal¹⁸, Neil Houston¹⁹, Tamzin Brott²⁰, David Ryan²¹, Jocelyn Peach²², Andrew Brant²³, Dale Bramley²⁴

Affiliations

¹ Lead Advisor, Improvement, Research & Informatics, Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
² Director, Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
³ Medical Fellow, Planning, Funding and Outcomes, Waitemata DHB, Auckland.
⁴ Information Analyst, Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
⁵ Clinical Coding Auditor, Health Information Group, Waitemata DHB, Auckland.
⁶ Clinical Coding Team Leader, Health Information Group, Waitemata DHB, Auckland.
⁷ Senior Lecturer, Department of Population Health, University of Otago, Christchurch.
⁸ Professor, Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland.
⁹ Independent Consultant, Seddon Healthcare Quality, Auckland.
¹⁰ Senior Lecturer, School of Management, Massey University, Auckland.
¹¹ Associate Professor, School of Pharmacy, University of Auckland, Auckland.
¹² Chief Advisor for Asian International Collaboration, Waitemata District Health Board, Auckland.
¹³ Senior Lecturer, School of Population Health, University of Auckland, Auckland.
¹⁴ Public Health Physician (Surgical), Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
¹⁵ Public Health Physician (Maternity), Child, Women and Family, Waitemata DHB, Auckland.
¹⁶ Senior Research Fellow, Department of Geriatric Medicine, University of Auckland, Auckland.
¹⁷ Chief Pharmacist, Pharmacy Department, Waitemata DHB, Auckland.
¹⁸ Medication Safety Pharmacist, Pharmacy Department, Waitemata DHB, Auckland (Died 24 April 2018).
¹⁹ Clinical Director for Safety and Quality in Primary Care, Waitemata DHB, Auckland.
²⁰ Executive Director-Allied Health, Scientific & Technical Professions, Waitemata DHB, Auckland.
²¹ Information Systems Change Manager, Health Information Group, Waitemata DHB, Auckland.
²² Director of Nursing and Midwifery, Waitemata DHB, Auckland.
²³ Chief Medical Officer, Waitemata DHB, Auckland.
²⁴ Chief Executive Officer, Waitemata DHB, Auckland.

PMID: 30359356

Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Jerome Ng et al. N Z Med J. 2018.

. 2018 Oct 26;131(1484):46-60.

Authors

Affiliations

¹ Lead Advisor, Improvement, Research & Informatics, Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
² Director, Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
³ Medical Fellow, Planning, Funding and Outcomes, Waitemata DHB, Auckland.
⁴ Information Analyst, Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
⁵ Clinical Coding Auditor, Health Information Group, Waitemata DHB, Auckland.
⁶ Clinical Coding Team Leader, Health Information Group, Waitemata DHB, Auckland.
⁷ Senior Lecturer, Department of Population Health, University of Otago, Christchurch.
⁸ Professor, Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland.
⁹ Independent Consultant, Seddon Healthcare Quality, Auckland.
¹⁰ Senior Lecturer, School of Management, Massey University, Auckland.
¹¹ Associate Professor, School of Pharmacy, University of Auckland, Auckland.
¹² Chief Advisor for Asian International Collaboration, Waitemata District Health Board, Auckland.
¹³ Senior Lecturer, School of Population Health, University of Auckland, Auckland.
¹⁴ Public Health Physician (Surgical), Institute for Innovation and Improvement (i3), Waitemata DHB, Auckland.
¹⁵ Public Health Physician (Maternity), Child, Women and Family, Waitemata DHB, Auckland.
¹⁶ Senior Research Fellow, Department of Geriatric Medicine, University of Auckland, Auckland.
¹⁷ Chief Pharmacist, Pharmacy Department, Waitemata DHB, Auckland.
¹⁸ Medication Safety Pharmacist, Pharmacy Department, Waitemata DHB, Auckland (Died 24 April 2018).
¹⁹ Clinical Director for Safety and Quality in Primary Care, Waitemata DHB, Auckland.
²⁰ Executive Director-Allied Health, Scientific & Technical Professions, Waitemata DHB, Auckland.
²¹ Information Systems Change Manager, Health Information Group, Waitemata DHB, Auckland.
²² Director of Nursing and Midwifery, Waitemata DHB, Auckland.
²³ Chief Medical Officer, Waitemata DHB, Auckland.
²⁴ Chief Executive Officer, Waitemata DHB, Auckland.

PMID: 30359356

Abstract

Aim: To explore the feasibility and reliability of Clinical Coding Surveillance (CCS) for the routine monitoring of Adverse Drug Events (ADE) and describe the characteristics of harm identified through this approach in a large district health board (DHB).

Method: All hospital admissions at Waitemata DHB from 2015 to 2016 with an ADE-related ICD10-AM code of Y40-Y59, X40-X49 or T36-T50 were extracted from clinical coded data. The data was analysed using descriptive statistics, statistical process control and Pareto charts. Two clinicians assessed a random sample of 140 ADEs for their accuracy against what was clinically documented in medical records.

Results: A total of 11,999 ADEs were identified in 244,992 admissions (4.9 ADEs per 100 admissions). ADEs were more prevalent in older adults and associated with longer average length of stays and medicines such as analgesics, antibiotics, anticoagulants and diuretics. Only 2,164 (18%) of ADEs were classified as originating within hospital. Of ADEs originating outside of the hospital, the main causes were poisoning by psychotropics, anti-epileptics and anti-parkinsonism agents and non-opioid analgesics. Clinicians agreed that 91% of ADE positive admissions were accurately classified as per clinical documentation.

Conclusion: CCS is a feasible and reliable approach for the routine monitoring of ADEs in hospitals.

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Conflict of interest statement

Nil.

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Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Affiliations

Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms