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Electronic System Alerts Pharmacists to Potential Adverse Drug Events

Donna Young

Community Health Network of Indianapolis, Indiana, is using an electronic alerting system that could help pharmacists intervene before an adverse drug event (ADE) occurs.

Clinical Event Manager, a commercial product, immediately sends laboratory test results and other clinical data to a pharmacist’s e-mail address or text pager.

The product also can be programmed to send alerts directly to a printer or fax machine, according to the system’s manufacturer, Sunquest Information Systems Inc. of Tucson, Arizona.

Alerts in action. Dan Degnan, pharmacy facility leader for Community Hospital North, said the electronic alerting system notifies the health system’s pharmacists when a patient’s test results are abnormal or there is potential for an ADE.

For instance, Degnan said, when a patient is admitted to the hospital, the admissions–discharge–transfer system sends data, such as drug allergies, directly to Community’s other databases, including pharmacy, laboratory, radiology, and automated drug-dispensing systems. If the patient is allergic to penicillin but a physician orders the drug for the patient, an alert is immediately triggered and the pharmacist can intervene.

The electronic alerting system could be programmed to notify a pharmacist when a laboratory test result shows that a patient’s serum potassium level is too low or too high or when a patient’s medication dosage should be adjusted, Degnan said.

At Community, the alerting system has "probably saved two lives," Degnan claimed.

Pharmacists intervened, Degnan said, in "at least two known events when serious dosing errors" could have occurred with cancer chemotherapy drugs that were going to be administered.

"The system alerts the chemo-certified nurse and a decentralized pharmacist, that is assigned to monitor the patient, when the chemotherapy drugs are ready to be administered," he said. "Because of patient rounds, they both have knowledge of what the physician's intent for the order should be. The alert tells them the dosage. They can communicate with the physician and the pharmacy if the dosage for the order that was entered into the computer does not match what they think was the intent."

Sunquest created Clinical Event Manager through a partnership with the University of Utah at Salt Lake City, said Patrick Pannier, the company’s product-line manager.

Pannier said the alerting system could be integrated with any health care database that uses Health Level Seven, or HL7, standards for electronic data exchange.

Degnan said Community’s research nurses use the system to alert them to patients who seem to qualify for an ongoing research protocol.

In addition to the pharmacists and research nurses, Community’s dietitians, infection control nurses, and case managers also subscribe to the electronic alerting system.

The health system’s cardiologists and pathologists have shown interest in using Clinical Event Manager, said Steve Hultgren, Community’s pharmacy network director. Community’s new cardiology center, expected to open in December 2002, will also be connected to the system.

Three of Community Health Network’s four hospitals are using the electronic alerting system. The network’s hospital in Anderson, northeast of Indianapolis, will have the system up and running within a few months, Degnan said.

Customization. Degnan said he and Dave Merryfield, Community’s clinical pharmacy coordinator, spent a week at Sunquest’s Salt Lake office in 1998 learning how to run the system.

Pannier said some of his company’s clients rely on Sunquest to program new triggers—such as lab test values, drug dosages, and other clinical data—into the system for them.

But, said Merryfield, Community’s pharmacists wanted the flexibility to modify the system themselves.

Community added Sunquest’s Rules Editor to the alerting system so subscribers would have the ability to design their own rules to trigger alerts and program new information directly into the system.

Merryfield said the alerting system is designed to contact a subscriber only after a self-selected trigger occurs. For a pharmacist, he said, that trigger could be the laboratory test result that the pharmacy had programmed the alerting system to recognize as potentially problematic if the patient was a certain age or receiving a certain medication.

Clinical Event Manager comes with about 400 rules already programmed into it, Pannier said.

Merryfield said his hospitals have customized and trimmed to about 200 the number of rules on its alerting system.

"You don’t want the rules to be too broad, or you get paged for everything," he said.

Documenting ADEs. In November, Community added a component that allows pharmacists to document information about ADEs directly into the alerting system.

"The alerting part of the system stays the same, but what is different is now someone doesn’t have to stop and fill out paperwork and enter it into another database that is separate," Merryfield said. "We have had two separate databases that didn’t talk to each other, and now it is all tied together."

Pannier said Sunquest used definitions from the American Society of Health-System Pharmacists and the World Health Organization to categorize the triggers for ADEs.

"The system lets us know immediately if something is going on," Hultgren said. "If a physician has ordered Benadryl for some reason, we can look at that and find out why they ordered it, such as if a patient had developed a rash as a result from an allergic reaction to an antibiotic. We can note it directly into the system."

Degnan said the new component saves time when trying to track ADEs.

"In the past, someone would have to do some data mining and sort through information," Degnan said. "Now we can document directly into the system what they did or exactly what they need to act on."

Pannier said the ADE component allows pharmacists to run monthly reports to track trends.

"They can see how many times an ADE trigger fired based on the input," he said. "They can see how they need to alter their therapy protocol."

Costs. Pannier said installation of Sunquest’s Clinical Event Manager costs about $100,000.

Merryfield said that, because Community acted as a beta test site for the company, costs to the health system ran several thousand dollars less than for other buyers.