The occurrence of adverse drug events (ADEs) is recognized as an important health care issue. This paper provides a review of the computer information systems that have been developed and used for the prevention of ADEs. Following an introductory section that defines concepts and terms, the clinical manifestations, influences, and costs of ADEs are reviewed, along with the medication classes, types, and causes of ADEs. Information systems that target different stages of the drug ordering and delivery process are discussed. Different studies show that computerized physician order entry systems are essential in the prevention of ADEs. Computer-assisted decision support programs that are integrated with systems that cover each stage of the drug ordering and delivery process provide the most powerful prevention tools. Through comparison with other methods, computer-based information systems are shown to be the most cost-effective and promising strategy for preventing ADEs. Further challenges and possible improvements are also discussed.
LazarousJPomeranzBHCoreyPNIncidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA.1998; 279:1200–1205.
2.
JhaAKKupermanGJTeichJMLeapeLSheaBRittenbergEBurdickESegerDLVlietMVBatesDWIdentifying adverse drug events: development of a computer-based monitor and comparison with chart review and simulated voluntary report. J Am Med Informatics Assoc.1998;5:305–314.
3.
JickH.Drugs remarkably non-toxic. N Engl J Med.1974;291:824–828.
4.
JohnsonJABootmanJLDrug-related morbidity and mortality. Arch Intern Med.1995;155:1949–1956.
5.
GrayJ.Bill would force drug makers to give customers data on risks. New York Times. July 25, 1996; All.
6.
World Health Organization.International drug monitoring: the role of the hospital. WHO Technical Report Series. Geneva, Switzerland: 1969;426:5–24.
7.
PearsonKCKennedyDLAdverse drug reactions and the Food and Drug Administration. J Pharm Pract.1989;2:209–213.
8.
Joint Commission on Accreditation of Healthcare Organizations.Accreditation Manual for Hospitals, 1991.Chicago, IL: Joint commission on Accreditation of Healthcare Organizations; 1991.
9.
LeapeLLLawthersAGBrennanTAJohnsonWGPreventing medical injury. Qual Rev Bull.1993;19: 144–149.
10.
LeapeLLError in medicine. JAMA.1994;272: 1851–1857.
11.
BatesDWCullenDLairdNPetersenLASmallSDServiDLaffelGSweitzerBJSheaBFHalliseyRVlietMVNemeskalRLeapeLLIncidence of adverse drug events and potential adverse drug events. JAMA.1995;274:29–34.
12.
ClassenDCPestotnikSLEvansRSLloydJFBurkeJPAdverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality. JAMA.1997;277:301–306.
13.
BatesDWSpellNCullenDJBurdickELairdNPetersenLASmallSDSweitzerBJLeapeLLThe cost of adverse drug events in hospitalized patients. JAMA.1997;277:307–311.
14.
LeapeLLBatesDWCullenDJCooperJDemonacoHJGallivanTHalliseyRIvesJLairdNLaffelGNemeskalRPetersenLAPorterKServiDSheaBFSmallSDSweitzerBJThompsonBTVlietMVSystem analysis of adverse drug events. JAMA.1995;274:35–43.
15.
LesarTSBricelandLSteinDSFactors related to errors in medication prescribing. JAMA.1997;277: 312–317.
16.
EvansRSPestotnikSLClassenDCHornSDBassSBBurkeJPPreventing adverse drug events in hospitalized patients. Ann Pharmacother.1994;28: 523–527.
17.
ClassenDCPestotnikSLEvansRSBurkeJPComputerized surveillance of adverse drug events in hospital patients. JAMA.1991;266:2847–2851.
18.
AndersonJGJaySJAndersonMHuntTJEvaluating the potential effectiveness of using computerized information systems to prevent adverse drug events. Proceedings of the American Medical Informatics Association Annual Fall Symposium.1997;228–232.
19.
BatesDWLeapeLLCullenDJLairdNPetersonLATeichJMBurdickEHickeyMKleefieldSSheaBVlietMVSegerDLEffect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA.1998;280:1311–1316.
20.
RaschkeRAGollihareBWunderlichTAGuidryJRLeibowitzAIPeirceJCLemelsonLHeislerMASusongC.A computer alert system to prevent injury from adverse drug events. JAMA.1998;280: 1317–1320.
21.
BrennanTALeapeLLLairdNMHerbertLLocalioARLawthersAGNewhouseJPWeilerPCHiattHHIncidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med.1991;324: 370–376.
22.
LeapeLLBrennanTALairdNLawthersAGLocalioARBarnesBAHerbertLNewhouseJPWeilerPCHiattH.The nature of adverse events in hospitalized patients: results of the Harvard Practice Study II. N Engl J Med.1991;324:377–384.
23.
CullenDJSweitzerBJBatesDWBurdickEEdmondsonALeapeLLPreventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. Crit Care Med.1997;25:1289–1297.
24.
PestotnikSLClassenDCEvansRSStevensLEBurkeJPProspective surveillance of imipenem/cilastatin use and associated seizures using a hospital information system. Ann Pharmacother.1993;27:497–501.
25.
EvansRSClassenDCPestotnikSLClemmerTPWeaverLKBurkeJPA decision support tool for antibiotic therapy. GardnerRM, ed. In: Proceedings From the Nineteenth Annual Symposium on Computer Applications in Medical Care.Philadelphia, PA: Hanley & Belfus; 1995:651–655.
26.
EvansRSPestotnikSLClassenDCClemmerTPWeaverLKOrmeJFLloydJFBurkeJPA computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med.1998; 338:232–238.
27.
SchiffGDRuckerD.Computerized prescribing: building the electronic infrastructure for better medication usage. JAMA.1998;279:1024–1029.
28.
TierneyWMMillerMEOverhageJMMcDonaldCJPhysician inpatient order writing on microcomputer workstations: effects on resource utilization. JAMA.1993;269:379–383.
29.
SchroederCGPeirpaoliPGDirect order entry by physicians in a computerized hospital information system. Am J Hosp Pharm.1986;43:355–359.
30.
CavutoNWoosleyRSaleM.Pharmacies and prevention of potentially fatal drug interactions. JAMA.1996;275:1086–1087.
31.
BatesDWLeapeLLPharmacies and prevention of potentially fatal drug interactions—in reply. JAMA.1996;275:1086–1087.
32.
BerryLLSegalRSherrinTPFudgeKASensitivity and specificity of three methods of detecting adverse drug relations. Am J Hosp Pharm.1988;45: 1534–1539.
33.
O'NeilACPetersonLACookEFBatesDWLeeTHBrennanTAPhysician reporting compared with medical-record review to identify adverse medical events. Ann Intern Med.1993;119:370–376.
34.
DugganDJBittnerMChenYMeltzerPTrentJMExpression profiling using cDNA microarrays. Nat Gen Suppl.1999;21:10–14.
35.
ChakravartiA.Population genetics—making sense out of sequence. Nat Gen Suppl.1999;21:56–60.
