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
- Recap of discussion 22 May 2008 Drug Safety Content Update
- 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
- Identification of a trigger for identification of an adverse medication reaction
- 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 cellsTrigger # | 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 |