Gandhi T K, Seger D L, Bates D W
Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Int J Qual Health Care. 2000 Feb;12(1):69-76. doi: 10.1093/intqhc/12.1.69.
Adverse drug events (ADEs), or injuries due to drugs, are common and often preventable. However, identifying ADEs, potential ADEs, and medication errors can be a major challenge. In this review, we describe methodologies that have been used to identify these events and give strategies for identification in non-study settings.
Methods such as voluntary reporting, chart review, and computerized monitoring for events have been most commonly used in studies of ADEs in inpatients. However, voluntary reporting, the method most hospitals currently use, has a very low yield of events. Chart review is much more sensitive but the costs are prohibitive. Computerized monitoring for ADEs (using rules or triggers) is a high yield and relatively inexpensive strategy that should be adopted by organizations. A limitation of this strategy, however, is that it identifies few medication errors and potential ADEs, which are also important. These can be captured through pharmacy logs, chart review, and direct observation. Once events have been identified, they can be classified by type of event, severity, and preventability. In non-study settings, the most practical method for identifying ADEs is computerized monitoring, and for identifying prescribing errors it is pharmacy logs of interventions. Once problems are found, a structure (either individual or committee) must be in place to classify them, identify opportunities for improvement, and carry out the necessary changes.
Health care organizations have the technology to significantly improve their detection of ADEs, medication errors, and potential ADEs. Identification and subsequent classification of events is crucial for quality efforts to improve patient safety.
药物不良事件（ADEs），即因药物导致的伤害，很常见且往往可预防。然而，识别ADEs、潜在的ADEs和用药错误可能是一项重大挑战。在本综述中，我们描述了用于识别这些事件的方法，并给出在非研究环境中的识别策略。
诸如自愿报告、病历审查和事件的计算机化监测等方法在住院患者ADEs研究中最常被使用。然而，自愿报告是目前大多数医院使用的方法，其事件检出率非常低。病历审查要敏感得多，但成本过高。ADEs的计算机化监测（使用规则或触发器）是一种高产出且相对廉价的策略，组织应采用。然而，该策略的一个局限性是它识别出的用药错误和潜在ADEs很少，而这些也很重要。这些可以通过药房日志、病历审查和直接观察来获取。一旦识别出事件，就可以按事件类型、严重程度和可预防性进行分类。在非研究环境中，识别ADEs最实用的方法是计算机化监测，识别处方错误的方法是干预措施的药房日志。一旦发现问题，必须有一个架构（个人或委员会）来对其进行分类，确定改进机会，并进行必要的更改。
医疗机构拥有技术手段来显著提高其对ADEs、用药错误和潜在ADEs的检测能力。事件的识别及后续分类对于提高患者安全的质量努力至关重要。
