Watchful waiting: clinical surveillance helps prevent drug reactions
The typical hospital inpatient is taking seven medications even before being admitted. Multiplied by hundreds of patients with multiple diagnoses, hospitals have a tremendous number of medications—and diagnoses and doses, interactions and side effects, adverse reactions and outcomes—to monitor.
Although medication management in the hospital setting may seem a daunting task, new informatics technologies and real-time computer tracking are tools ideally suited to helping clinicians reduce adverse drug events.
Christian A. Hartman, PharmD, MBA, assistant professor of medicine, has contributed a chapter to an important new textbook, Building Core Competencies in Pharmacy Informatics. This book will be used in pharmacy schools across the country as the nation’s health care centers embrace new technologies and tools to provide the safest and most effective care for patients. Hartman, an expert in medication safety, wrote the chapter on clinical surveillance systems.
Simply put, a clinical surveillance system is “watchful waiting,” Hartman said. More precisely, it is a software system that continually monitors and collates vast sets of information—medications, lab test results, and microbiology and patient-specific demographic information—and applies complex algorithms to provide care givers with real-time information that lets them plan for and react to a patient’s needs quickly and accurately.
Hartman, who received his bachelor’s degree at the Massachusetts College of Pharmacy, his PharmD at the University of Kansas, an MBA at UMass Amherst, and completed a fellowship through Virginia Commonwealth University, built his first clinical surveillance system 10 years ago, writing rules for the program and designing algorithms. Since then, he has refined the system to provide not only daily reports for pharmacists, but a real-time dashboard for care givers. UMass Memorial Health Care, which is UMass Medical School’s clinical partner and has more than 780 inpatient beds and a formulary of more than 4,000 types of medications, implemented its own sophisticated system several years ago. Since then, it has become known in the pharmacy world as a leader in clinical surveillance, according to Hartman, who has spoken at conferences and consulted with pharmacy programs across the country and around the world.
Prior to implementing the electronic clinical surveillance system, UMass Memorial pharmacy staff would sift through paper medical records looking for medication interactions, signs of adverse events, or increasing kidney toxicity or duplicate therapies, and monitor the patient’s outcomes after treatment. Now, the program does the sifting more quickly and efficiently.
A clinical surveillance system can be used both prospectively—allowing clinicians to review certain data on patients with similar diagnoses and histories, before deciding upon a course of treatment—and retrospectively to identify trends related to treatment courses or other factors, and help improve patient safety and care.
For example, the number one cause of harm to patients in the hospital setting is a fall, Hartman said, which can often be related to medications. While some medications may cause balance issues, others may increase the need to urinate, requiring the patient to get out of bed more frequently, thus increasing the risk of falling. Informatics and clinical surveillance allow care givers to proactively adjust prescription treatment plans to avert problems for specific patients. It also allows the hospital to monitor its overall performance in preventing falls among at-risk patients.
“Pharmacy informatics has revolutionized patient care and provided a critical tool for improving not only medication safety but health care as a whole,” said Hartman, who will be teaching a course in clinical surveillance systems at the Massachusetts College of Pharmacy and Health Sciences next spring.
Building Core Competencies in Pharmacy Informatics is published by the American Pharmacists Association.
