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Published on: December 1, 2020
Understanding pharmacist decision making for adverse drug event (ADE) detection
Shobha Phansalkar1, Jennifer M Hoffman, John F Hurdle
1Brigham and Women's Hospital, Boston, MA, USA. sphansalkar@partners.org
Journal of Evaluation in Clinical Practice
|April 2, 2009
Summary
Pharmacists use forward reasoning to detect adverse drug events (ADEs), but often lack sufficient information. Developing better alerting systems can improve ADE detection and patient safety.
Area of Science:
- Pharmacology
- Health Informatics
- Clinical Pharmacy
Background:
- Manual chart review for adverse drug event (ADE) detection is effective but costly.
- Expert systems can improve efficiency and reduce costs by mimicking human decision-making.
- This study investigates pharmacist decision-making for ADE detection as a foundational step.
Purpose of the Study:
- To explore pharmacist decision-making processes in adverse drug event detection.
- To identify information signals and unmet information needs during ADE detection.
- To inform the development of expert systems for improved ADE detection.
Main Methods:
- Think-aloud procedures were employed with pharmacists reviewing ADE case scenarios.
- Verbal protocols were qualitatively analyzed to extract decision-making strategies and information needs.
- Inter-reviewer agreement for classifying ADE information signals was assessed using Cohen's kappa.
Main Results:
- 110 information signals were extracted; 73% were interpreted from the scenario, and 53% were relevant for ADE detection.
- Excellent inter-reviewer reliability was achieved in classifying signals.
- Fifty information signals related to unmet information needs were identified and themed.
Conclusions:
- Pharmacists utilize forward reasoning for hypothesis validation in ADE detection.
- Frequent unmet information needs were identified, highlighting areas for system improvement.
- Developing targeted alerting systems can enhance pharmacists' ability to reduce preventable ADEs and improve patient safety.
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