Adverse drug reactions and electronic health record management systems

EHR Database and Data Management

Database Management Approach

The issue to address is the negative effects of drugs. Adverse reaction to drugs is "a significantly unpleasant or dangerous response caused by an intervention that is linked with using some kind of medicine, which predicts danger from future usage and assures prevention or a particular kind of treatment, a dosage regimen modification, or withdrawing from the drug" (Edwards & Aronson, 2000).

Description of the patient problem

ADRs (Adverse Drug Reaction) are among the top mortality and morbidity causes in medical care. On January 2000, the Medicine Institute stated that between 44,000 and 98,000 mortalities take place each year due to health care errors (Committee on Quality of Health Care in America (Institute of Medicine), 2000). ADRs caused around 7000 mortalities out of the stated total. Keep in mind that in America, job related injuries cause around 6000 annual mortalities. The next question to ask should be, how much does it cost medical care due to such negative reactions to drugs? Again, there are methodological constraints that make it difficult for estimates to be completely accurate. However, one annual cost estimate with regard to drug-caused mortality and morbidity is $136 billion, which amounts to more than USA's diabetic and cardiovascular care costs combined. Furthermore, a fifth of the annual mortalities and injuries among patients who have been hospitalized are likely to be due to negative reactions to drugs. In conclusion, there is twice the average time of stay, mortality rate and expenses among hospitalized patients afflicted with negative reactions to drugs, in comparison to those without ADRs within a control patient group. Current publications indicate that several ADRs are detectible and preventable by means of systems help. For instance, several medical systems have established new technologies for ensuring minimal patient injury caused by interactions of drugs and health care errors. Tools such as computerized prescription entry and doctor order as well as systems for bar coding have brought about significant benefits. It has been acknowledged that there is great potential for reducing medication errors through computerized health records and software for medicine-interaction screening that informs pharmacists and doctors of severe medicine interactions (FDA.gov, 2016).

Management: The Electronic Health Record (EHR).

The record should indicate the history of a patient's medical condition, and other medical care providers should be able to access it in order to be aware of the health problems or concerns of a patient. The records of every patient, whether or not they have been seen, need to include a significant and focused medical history, a documented evaluation and a suitable focused physical diagnosis; if it is indicated, with a provisional exam; also if indicated as well as, a management strategy (CPSO, 2012). Thus, this information includes:

• Identification details of the patient (name, contact number, OHIP (?) number, address); Comment by GL: Full name

• Personal information and family details (job, habits, life events, family health history);

• Previous medical history (previous critical illnesses, surgeries, genetic history, accidents);

• Risk aspects;

• Drug reactions and allergies;

• Current medical conditions (diagnoses, problems, onset date);

• Health protection (yearly diagnoses, vaccinations, disease monitoring, e.g., bone density, colonoscopy, mammogram);

• Names of consultants;

• Long-term health care (current drugs, frequency, dosage);

• Major exams;

• Emergency contact.

These details should be filled out the first time or second time a medical care provider meets a patient, and it should be seen clearly in the record of the patient for easy reference and access. Nonetheless, doctors should start to keep patient CPPs (?) in a practice that exists, even in places where this practice is new. Many EMRs (Electronic Medical Records) will routinely compile patient details in CPPs while it is put down on other parts of the patients' records. Comment by GL: Full name

Doctors need to read through the CPP contents during every consultation and reread the details subsequently. This is similarly significant for doctors that use EMRs. Frequent rereading and review is especially significant where doctors need to forward the details to such third parties as ERs, health consultants, insurance companies as well as lawyers. In such cases, doctors need to make sure they forward up-to-date and accurate details (CPSO, 2012).

Other details that are normally indicated in EHRs for hospitalized patients are;

They can be recognized by those patients who might have experienced ADE (?) within 24-hour surveillance of signals by patients." These signals, which are regularly put down in health records, show the possibility that there may have been an ADE: Comment by GL: Full-form, please

• Change in heart rate, hearing, breathing rate, or mental condition.

• Specific lab results, low or high levels of blood of specific, wrong drug dosage for a patient's weight or age as well as chemist's medical recommendations for treating an allergic reaction.

A virtual alert system installed in a regional Heath Centre known as Good Samaritan was meant for identifying and informing medical care provider of ADEs and errors in prescription. Details included in the database are the patient's lab results, radiology orders, pharmacy orders, medicine allergies, as well as demographic factors (Raschke, Collihare, & Wunderlich, 1998).

Description of data relationships that apply to the hypothetical database

Medicine exposure in EHR is identified using either administration or prescription information, through ATC (?) codes. Recommendations with similar ATC codes; and different prescription dates for different drugs are put into one drug-use episode, beginning with the preceding recommendation, and the final recommendation, last. Concomitant drug administration periods were identified as distinct episodes. The only drug exposure considered is the current one; within a month of the event in question (Hui, Vaillancourt, Bair, Wong, & King, 2016). Comment by GL: Full form

The consistency and accuracy of documenting ADR within the basic documentation system of a hospital should be assessed by comparison of the type and number of ADR cases within every system. Documentation of ADR will be restored from three single medical record systems for documentation: paper charts together with an HER (?) for a hospitalized patient with only allied health and nursing documentation, the chemist system as well as EHR system for ambulances. Comment by GL: Full form