Checklist-Based Identification of Adverse Drug Reactions in Emergency Department Patients

Area of Science:

• Pharmacovigilance
• Emergency Medicine
• Clinical Pharmacology

Background:

• Emergency departments (EDs) manage diverse patient complaints, with adverse drug reactions (ADRs) being a potential underlying cause.
• Accurate ADR identification in the ED is crucial for optimizing pharmacotherapy and preventing patient harm.
• Overlooked ADRs can lead to serious consequences, necessitating improved detection methods.

Purpose of the Study:

• To evaluate the effectiveness of a checklist-based method for identifying ADRs as a reason for ED presentation.
• To compare ADR identification rates between a checklist method and routine physician documentation in the ED.
• To assess the potential for improving ADR detection through systematic review.

Main Methods:

• Retrospective analysis of medical records for patients presenting to the ED.
• Two assessment phases: (1) evaluation using a predefined checklist by an independent examiner, and (2) review of ADRs documented by ED physicians.
• Statistical comparison using the McNemar test to analyze discrepancies in ADR identification.

Main Results:

• Out of 34,747 evaluated patients, a checklist identified 2071 (6.0%) ADRs as the cause for ED visit.
• ED physicians documented ADRs in only 828 (2.4%) patients.
• The checklist method significantly improved ADR identification compared to routine care (6.0% vs. 2.4%, p < 0.001).
• Worsened general condition was the most frequent chief complaint, and antithrombotics were the most common drug class implicated in ADRs.

Conclusions:

• ADRs are frequently overlooked in routine ED care, as evidenced by the higher detection rate using a checklist.
• Implementing a checklist-based approach in routine ED processes can significantly enhance the identification of ADRs.
• Improved ADR detection has the potential to optimize drug therapy and prevent patient harm.