Minutes Drugs Safety Content Profile June 5, 2008

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Drug Safety Content Profile

Minutes, 5 June 2008 Conference Call (1:00 - 1:30 PM CDT); Meeting ended early due to low attendance;

Attendees;

  • Floyd Eisenberg (Siemens)
  • Jason Colquitt (Greenway Medical Systems)
  • Carolyn Dunaway-Shanks (Siemens
  • Jan Orton (Intermountain Healthcare)
  • Daemon Whittenburg (Greenway Medical Systems)

Discussion

Profile Proposal

  • Primary issues with creation of this profile include;
    • Identification of a trigger for identification of an adverse medication reaction
      • Jan Orton will review potential availability of triggers with her organization
      • Addtional sources for triggers:
        • Institute for Healthcare Improvement [(IHI) http://www.ihi.org/ihi/workspace/tools/trigger/ ADE Trigger Tools]
        • Rozich JD, Haraden CR, Resar RK. Adverse drug event trigger tool: a practical methodology for measuring medication related harm, Qual Saf Health Care. 2003;12:194-200. - Lists 24 clinical triggers to identify potential adverse drug events. *** See Table Below for 24 Triggers
        • Resar RK, Rozich JK, Classen D. Methodology and rationale for the measurement of harm with trigger tools, Qual Saf Health Care. 2003;12:ii30-ii45.
        • Takata GS, Mason W, Taketomo C, Logsdon T and Sharek PJ. Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children's Hospitals. Pediatrics 2008;121:927-935. Full Text of Article
    • Mapping of ICSR2 to CCD
  • Determine readiness with respect to existing standards - requires more participation
  • Next steps - Reschedule for follow up


Rozich, Haraden, Resar - Clinical Triggers

Acronyms: PTT=prothrombin time; INR=international normalized ratio; WBC=white blood cells
Trigger # Trigger Concern EHR Trigger Type (added)
T1 Diphenhydramine Hypersensitivity reaction or drug effect Order
T2 Vitamin K Over-anticoagulation with warfarin Order
T3 Flumazenil Oversedation with benzodiazepine Order
T4 Droperidol Nausea/emesis related to drug use Order
T5 Naloxone Oversedation with narcotic Order
T6 Antidiarrheals Adverse drug event Order
T7 Sodium polystyrene Hyperkalemia related to renal impairment or drug effect Order
T8 PTT >100 seconds Over-anticoagulation with heparin Result occurrence
T9 INR >6 Over-anticoagulation with warfarin Result occurrence
T10 WBC <3000 × 106/μl Neutropenia related to drug or disease Result occurrence
T11 Serum glucose <50 mg/dl Hypoglycemia related to insulin use Result occurrence
T12 Rising serum creatinine Renal insufficiency related to drug use Result occurence (calculated delta)
T13 Clostridium difficile positive stool Exposure to antibiotics Result occurrence (perhaps order for stool C difficile)
T14 Digoxin level >2 ng/ml Toxic digoxin level Result occurrence
T15 Lidocaine level >5 ng/ml Toxic lidocaine level Result occurrence
T16 Gentamicin or tobramycin levels peak >10 μg/ml,trough >2 μg/ml Toxic levels of antibiotics Result occurrence
T17 Amikacin levels peak >30 μg/ml, trough >10 μg/ml Toxic levels of antibiotics Result occurrence
T18 Vancomycin level >26 μg/ml Toxic levels of antibiotics Result occurrence
T19 Theophylline level >20 μg/ml Toxic levels of drug Result occurrence
T20 Oversedation, lethargy, falls Related to overuse of medication Occurrence of finding/observation
T21 Rash Drug related/adverse drug event Occurrence of finding/observation
T22 Abrupt medication stop Adverse drug event Order to discontinue
T23 Transfer to higher level of care Adverse event Order
T24 Customized to individual institution Adverse event Local determinant
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