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Tailoring adverse drug event surveillance to the paediatric inpatient
  1. Andrea L Long1,2,
  2. Monica M Horvath1,
  3. Heidi Cozart1,
  4. Julie Eckstrand1,
  5. Julie Whitehurst1,
  6. Jeffrey Ferranti1
  1. 1Duke University Health System, Durham, North Carolina, USA
  2. 2Duke Health Technology Solutions, Durham, North Carolina, USA
  1. Correspondence to Dr Andrea L Long, Duke Health Technology Solutions, 2424 Erwin Road, DUMC 2718, Durham, NC 27710, USA; andrea.long{at}


Introduction Although paediatric patients have an increased risk for adverse drug events, few detection methodologies target this population. To utilise computerised adverse event surveillance, specialised trigger rules are required to accommodate the unique needs of children. The aim was to develop new, tailored rules sustainable for review and robust enough to support aggregate event rate monitoring.

Methods The authors utilised a voluntary staff incident-reporting system, lab values and physician insight to design trigger rules. During Phase 1, problem areas were identified by reviewing 5 years of paediatric voluntary incident reports. Based on these findings, historical lab electrolyte values were analysed to devise critical value thresholds. This evidence informed Phase 2 rule development. For 3 months, surveillance alerts were evaluated for occurrence of adverse drug events.

Results In Phase 1, replacement preparations and total parenteral nutrition comprised the majority (36.6%) of adverse drug events in 353 paediatric patients. During Phase 2, nine new trigger rules produced 225 alerts in 103 paediatric inpatients. Of these, 14 adverse drug events were found by the paediatric hypoglycaemia rule, but all other electrolyte trigger rules were ineffective. Compared with the adult-focused hypoglycaemia rule, the new, tailored version increased the paediatric event detection rate from 0.43 to 1.51 events per 1000 patient days.

Conclusions Relying solely on absolute lab values to detect electrolyte-related adverse drug events did not meet our goals. Use of compound rule logic improved detection of hypoglycaemia. More success may be found in designing real-time rules that leverage lab trends and additional clinical information.

  • Paediatrics
  • adverse drug event
  • computerised surveillance
  • trigger tool
  • information technology
  • medication error

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding This study was supported by grant no 5UC1HS014882-03 from the Agency for Healthcare Research and Quality, National Institutes of Health.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Duke University Health System Institutional Review Board (Durham, NC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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