Johnstone D M, Kirking D M, Vinson B E
Department of Pharmaceutical Services, Michigan Capital Medical Center, Lansing, USA.
Am J Health Syst Pharm. 1995 Feb 1;52(3):297-301. doi: 10.1093/ajhp/52.3.297.
Adverse drug reactions (ADRs) detected by the pharmacy and medical records departments of a multispecialty teaching hospital were studied. The charts of all adult patients who were identified by the pharmacy or medical records departments as having had an ADR and who were discharged from the hospital between July and September 1990 were reviewed. Data on patient demographics and the characteristics of the ADRs were collected, and the causality and severity of each ADR were assessed by two pharmacists and one physician. A total of 110 charts representing 117 ADRs were reviewed. Twenty-five (21%) of the ADRs were identified by the pharmacy department and 101 (86%) by the medical records department; 9 (8%) were reported by both departments. The pharmacy and medical records groups of patients were demographically similar, except that the percentage of patients admitted through the emergency room was significantly smaller for the pharmacy department group. ADRs identified by the pharmacy were most commonly cutaneous, and those identified by medical records were most commonly neurologic. For the pharmacy department, hypersensitivity reactions accounted for the largest number of ADRs, while for medical records the largest number involved abnormal laboratory test values. Anti-infectives were involved in two thirds of the pharmacy-identified ADRs, compared with only a fifth of the ADRs identified by medical records. Mean causality and severity scores did not differ significantly between the groups. The medical records department identified four times as many ADRs as the pharmacy department. Observed differences in the number and types of reactions, manifestations, patient locations, and suspected drugs probably reflect the different surveillance methods and ADR definitions used by the two departments.
对一家多专科教学医院药房和病历科检测到的药物不良反应（ADR）进行了研究。查阅了1990年7月至9月期间药房或病历科确定发生过ADR且已出院的所有成年患者的病历。收集了患者人口统计学数据和ADR特征数据，由两名药剂师和一名医生对每种ADR的因果关系和严重程度进行评估。共查阅了代表117例ADR的110份病历。25例（21%）ADR由药房部门确定，101例（86%）由病历科确定；9例（8%）由两个部门共同报告。药房组和病历组患者在人口统计学上相似，只是药房部门组通过急诊室入院的患者百分比明显较低。药房确定的ADR最常见于皮肤，病历确定的ADR最常见于神经方面。对于药房部门，超敏反应占ADR的最大比例，而对于病历科，最大比例涉及实验室检查值异常。抗感染药物在药房确定的ADR中占三分之二，而在病历确定的ADR中仅占五分之一。两组之间的平均因果关系和严重程度评分无显著差异。病历科确定的ADR数量是药房部门的四倍。观察到的反应数量和类型、表现、患者所在科室以及可疑药物方面的差异，可能反映了两个部门使用的不同监测方法和ADR定义。
