Morning report: a forum for reporting adverse drug reactions

Most hospitals that monitor adverse drug reactions (ADRs) through reporting by nurses, pharmacists, medical record technicians, and quality improvement staff experience low rates of reporting. In teaching hospitals, inadequate orientation about the hospital activities, frequent changes in rotations between hospitals, and time commitments to educational pursuits may all undermine house staff's ability to perform ADR monitoring. The authors describe their experience since 1989 at the Department of Veterans Affairs Medical Center in Amarillo, Texas, in the use of verbal ADR reporting by physicians (mostly house staff) during the morning report in the medical service.

The morning report begins with a discussion of adverse outcomes of medications, usually from the previous 24 hours. The staff physicians use the opportunity to address the nature of the ADRs and the clinical circumstances leading up to them. Some ADR episodes require further peer review by a physician before being forwarded to the Pharmacy and Therapeutics Committee.

Since the start of the ADR monitoring program in 1989, the number of self-reported ADRs in the medical service has increased over historical controls, even though no special training was given to house staff to detect ADRs. The surgical and psychiatric services, which did not hold morning reports, did not experience the same increase in ADR reports.

The ADR monitoring program is notable for the simplicity of the reporting mechanism, the integration of the reporting into the regular work flow activities, the concurrent nature of the reporting, the educational opportunities, and the potential benefit for quality improvement of patient care.