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Implementing a clinical pharmacy survey of adverse drug events in a French emergency department

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Abstract

Background The prevalence of adverse drug events (ADEs) occurring in the ambulatory setting is high, requiring the development of a coherent and comprehensive patient-safety policy framework. Former experiences demonstrated that emergency department (ED) surveillance can help characterise the burden of outpatient ADEs. We developed a clinical pharmacy programme called the clinical pharmacy survey of adverse drug events (CPSA) to support interventions and research projects in the area of ADE prevention and management. Objective To design a survey to identify and describe ADEs in patients visiting the medical ED of our tertiary care hospital. We report the results of the first 2 years of CPSA implementation and an assessment of its performance. Setting The medical ED of a French 3,000-bed tertiary care hospital. Method Between January 2008 and December 2009, adult patients visiting our medical ED were included during randomised time slots. Data were collected by pharmacy students. ADEs were documented by a trained physician pharmacist team using the chart review method. Main outcome measure The primary outcome was the number of patients visiting our ED with an ADE. The CPSA attributes were assessed on the basis of the Centers for Disease Control and Prevention’s 2001 updated guidelines for evaluating public health surveillance systems. Results Of the 1,035 included patients, 201 experienced an ADE at the ED visit (19.4 %; 95 % confidence interval 15.8–23.0 %). Forty-seven ADEs (23.4 %) were unrelated to the patient’s chief complaint. An ADE was the leading cause of 154 in the 1,035 admissions (14.9 %). The assessment of our method on the basis of the Centers for Disease Control and Prevention guidelines showed good performances in terms of data quality, stability, flexibility, timeliness, and acceptability, but not in terms of simplicity and representativeness. The profile of patients with an ADE at admission and detected ADEs did not significantly differ between years 2008 and 2009. Conclusion Our experience demonstrates that clinical pharmacists can successfully implement a survey process of ADEs in an ED over time. Our method seems basic enough to suit most health care facilities with pharmacy students.

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Acknowledgments

The authors thank Guillaume Brément, Sébastien Ruaud, Claire Denis, Laura Bloino, Claire Delville, Marion Cruveilhier, Romain Goument, Pierre-Yves Joubi, Emilie Peron, Thibaut Grare, Emilie Simon, Florence Renaudineau, Julie Lambert, Xavier Guy, Charlotte Bronsard, Alice Bozec, Emilie Bouju, Cyrille Puel and Mélanie Bonal for carrying out data collection.

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Conflicts of interests

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Emergency Department, Teaching Hospital, Nantes, France

    Lucien Roulet, Nathalie Asseray, Martin Dary & Gilles Potel

  2. Faculty of Medical Sciences, UPRES EA 3826, 1 rue Gaston Veil, 44035, Nantes, France

    Lucien Roulet, Nathalie Asseray, Gilles Potel & Françoise Ballereau

  3. Department of Clinical Pharmacology, Teaching Hospital, Nantes, France

    Anne Chiffoleau

  4. Medqual, Teaching Hospital, Nantes, France

    Françoise Ballereau

Authors
  1. Lucien Roulet
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  2. Nathalie Asseray
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  4. Anne Chiffoleau
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  5. Gilles Potel
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  6. Françoise Ballereau
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Corresponding author

Correspondence to Lucien Roulet.

Appendix

Appendix

Definitions of the nine attributes of a surveillance system (excerpt from the Centers for Disease Control and Prevention’s 2001 updated guidelines for evaluating public health surveillance systems [28])

  1. 1.

    Simplicity

The simplicity of a public health surveillance system refers to both its structure and ease of operation. Surveillance systems should be as simple as possible while still meeting their objectives.

  1. 2.

    Flexibility

A flexible public health surveillance system can adapt to changing information needs or operating conditions with little additional time, personnel, or allocated funds.

  1. 3.

    Data quality

Data quality reflects the completeness and validity of the data recorded in the public health surveillance system.

  1. 4.

    Acceptability

Acceptability reflects the willingness of persons and organizations to participate in the surveillance system.

  1. 5.

    Sensitivity

The sensitivity of a surveillance system refers to the proportion of cases of a disease (or other health-related event) detected by the surveillance system.

  1. 6.

    Predictive value positive

Predictive value positive (PVP) is the proportion of reported cases that actually have the health-related event under surveillance.

  1. 7.

    Representativeness

A public health surveillance system that is representative accurately describes the occurrence of a health-related event over time and its distribution in the population by place and person.

  1. 8.

    Timeliness

Timeliness reflects the speed between steps in a public health surveillance system.

  1. 9.

    Stability

Stability refers to the reliability (i.e., the ability to collect, manage, and provide data properly without failure) and availability (the ability to be operational when it is needed) of the public health surveillance system.

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Roulet, L., Asseray, N., Dary, M. et al. Implementing a clinical pharmacy survey of adverse drug events in a French emergency department. Int J Clin Pharm 34, 902–910 (2012). https://doi.org/10.1007/s11096-012-9691-6

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  • DOI: https://doi.org/10.1007/s11096-012-9691-6

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