Monitoring adverse drug reactions: scales, profiles, and checklists

Globally, adverse drug reactions (ADRs) make a substantial contribution to ill health. Introducing a systematic approach to patient surveillance could mitigate these problems. Formalized medication monitoring schedules have been proposed as one strategy to diagnose and action side-effects and the problems emanating from adverse drug reactions. To date, most developments have been linked to antipsychotic medications. Several scales, checklists, and side-effect profiles are available, including the West Wales ADR (adverse drug reaction) profile. However, relatively little work has been undertaken on the clinical validity, reliability, and sensitivity of these instruments.

This paper describes the development of the monitoring schedule approach to medication management. It also reviews and compares the instruments available for monitoring the adverse drug reactions of antipsychotic medications. The UKU (Udvalg for Kliniske Undersogelser) scale and the West Wales ADR profile assess a broader range of physiological parameters and potential problems than other instruments. However, to be adopted in practice, such instruments must achieve a balance between clinical gain and practical cost, including the time spent in administration.

Further work is needed to explore the translation of formalized ADR surveillance programmes into clinical gains and improved outcomes for clients.