Adverse drug reactions: the San Juan Department of Veterans Affairs Medical Center experience.

The San Juan Department of Veterans Affairs Medical Center's adverse drug reactions (ADRs) reporting and monitoring program is described. ADRs for the first 2 years of the program are discussed. These were mainly hypersensitivity (29.3%), drug intoxications (19.9%), cardiovascular (15.9%), hematologic (7.6%), neurologic (4.9%), and gastrointestinal (4.7%) ADRs. Drugs most frequently involved were antibiotics (28.7%), cardiovascular agents (21.2%), anticonvulsants (10.2%), psychotropics (9.4%), and theophylline (5.1%). Preventive interventions include the development of a clinical pharmacist-run anticoagulation clinic, a drug utilization evaluation of phenytoin, development of a dosing algorithm for theophylline, and the possible future initiation of a pharmacokinetic consult service. The success of the ADR program is evidenced by a 750% increase in ADR reports over the 2-year period. This was possible by the establishment of a clear definition of an ADR, the creation of a simple reporting method, and an ongoing educational campaign.