Sivaram C A, Johnson S, Tirmizi S N, Robertson V, Garcia D, Sorrells E
Department of Veterans Affairs Medical Center, Amarillo, Texas, USA.
Jt Comm J Qual Improv. 1996 Apr;22(4):259-63. doi: 10.1016/s1070-3241(16)30229-2.
Most hospitals that monitor adverse drug reactions (ADRs) through reporting by nurses, pharmacists, medical record technicians, and quality improvement staff experience low rates of reporting. In teaching hospitals, inadequate orientation about the hospital activities, frequent changes in rotations between hospitals, and time commitments to educational pursuits may all undermine house staff's ability to perform ADR monitoring. The authors describe their experience since 1989 at the Department of Veterans Affairs Medical Center in Amarillo, Texas, in the use of verbal ADR reporting by physicians (mostly house staff) during the morning report in the medical service.
The morning report begins with a discussion of adverse outcomes of medications, usually from the previous 24 hours. The staff physicians use the opportunity to address the nature of the ADRs and the clinical circumstances leading up to them. Some ADR episodes require further peer review by a physician before being forwarded to the Pharmacy and Therapeutics Committee.
Since the start of the ADR monitoring program in 1989, the number of self-reported ADRs in the medical service has increased over historical controls, even though no special training was given to house staff to detect ADRs. The surgical and psychiatric services, which did not hold morning reports, did not experience the same increase in ADR reports.
The ADR monitoring program is notable for the simplicity of the reporting mechanism, the integration of the reporting into the regular work flow activities, the concurrent nature of the reporting, the educational opportunities, and the potential benefit for quality improvement of patient care.
大多数通过护士、药剂师、病历技术员和质量改进人员报告来监测药物不良反应（ADR）的医院，报告率都很低。在教学医院，对医院活动的入职培训不足、医院间轮转的频繁变化以及对教育活动的时间投入，都可能削弱住院医生进行ADR监测的能力。作者描述了自1989年以来他们在得克萨斯州阿马里洛退伍军人事务医疗中心，在医疗服务早交班期间使用医生（主要是住院医生）口头报告ADR的经验。
ADR监测项目：早交班开始时会讨论药物的不良后果，通常是前24小时内的。主治医师利用这个机会阐述ADR的性质以及导致这些ADR的临床情况。一些ADR事件在提交给药学与治疗学委员会之前，需要医生进行进一步的同行评审。
自1989年ADR监测项目启动以来，即使没有对住院医生进行检测ADR的专门培训，医疗服务中自我报告的ADR数量也比历史对照有所增加。未进行早交班的外科和精神科服务部门，ADR报告数量没有出现同样的增加。
ADR监测项目的显著特点在于报告机制简单、报告融入常规工作流程、报告具有同步性、提供了教育机会以及对改善患者护理质量具有潜在益处。
