Exploring in-hospital adverse drug events using ICD-10 codes.

OBJECTIVE: Adverse drug events (ADEs) during hospital admissions are a widespread problem associated with adverse patient outcomes. The 'external cause' codes in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) provide opportunities for identifying the incidence of ADEs acquired during hospital stays that may assist in targeting interventions to decrease their occurrence. The aim of the present study was to use routine administrative data to identify ADEs acquired during hospital admissions in a suburban healthcare network in Melbourne, Australia. METHODS: Thirty-nine secondary diagnosis fields of hospital discharge data for a 1-year period were reviewed for 'diagnoses not present on admission' and assigned to the Classification of Hospital Acquired Diagnoses (CHADx) subclasses. Discharges with one or more ADE subclass were extracted for retrospective analysis. RESULTS: From 57205 hospital discharges, 7891 discharges (13.8%) had at least one CHADx, and 402 discharges (0.7%) had an ADE recorded. The highest proportion of ADEs was due to administration of analgesics (27%) and systemic antibiotics (23%). Other major contributors were anticoagulation (13%), anaesthesia (9%) and medications with cardiovascular side-effects (9%). CONCLUSION: Hospital data coded in ICD-10 can be used to identify ADEs that occur during hospital stays and also clinical conditions, therapeutic drug classes and treating units where these occur. Using the CHADx algorithm on administrative datasets provides a consistent and economical method for such ADE monitoring.

Clinical pharmacy workload in medical and surgical patients: effect of patient partition, disease complexity and major disease category.

OBJECTIVES: The aim of this study was to measure the time spent providing clinical pharmacy services to individual patient episodes for general medical and surgical patients and to measure the effect of patient presentation and complexity on this workload. METHODS: We conducted a 5-month study at The Northern Hospital and Western Hospital in Melbourne, Australia, during 2006. Pharmacists recorded a defined range of activities that they provided for individual patients, including the actual times required for these tasks. A customised database, linked to the two hospitals' patient administration systems, stored these data according to the specific patient episode number. We then examined the influence of patient presentation and complexity on clinical pharmacy activities provided. KEY FINDINGS: During intervals when pharmacists recorded the time required to conduct activities, the average time required to perform the medication history and reconciliation exercise on 3052 occasions was 9.6 +/- 4.5 min. The 1844 interventions required an average of 5.9 +/- 3.0 min, clinical review of the patient's medical record required 5.5 +/- 2.7 min and medication order review required 3.5 +/- 1.3 min. For all of these activities, the time required was greater for medical patients than for surgical patients and greater for patients whose Diagnosis Related Group classification included a complication or co-morbidity. The average time required to perform all clinical pharmacy activities for 4625 completed patient episodes was 22.4 +/- 16.7 min and was again greater for medical patients and for patients with a complication or co-morbidity. CONCLUSIONS: The times required to perform a range of clinical pharmacy activities for individual patients was affected by whether the patients were medical or surgical patients. Furthermore, the existence of co-morbidities or complications affected these times. The methodology has potential application for other patient presentations and in other practice settings.

Identification by observation of clinical pharmacists' activities in a hospital inpatient setting

The aim of the study was to quantify clinical pharmacists’ workload in Australia. Specific objectives were to perform a direct observation of the pattern of clinical activities in two acute hospitals and compare that with previously documented self reported patterns. We were also interested in identifying what records kept by pharmacists would capture all the activities they perform. Methods: An observer recorded the activities of clinical pharmacists on six separate days in the medical and surgical wards of two Melbourne metropolitan hospitals. We examined resultant datato determine suitable records by which clinical pharmacists could capture all the activities they perform. To compare the observed pattern of clinical activities with those earlier self-reported by pharmacists, we categorised our data using the Pharmacy Activity Codes present in the penultimate version of the ICD-10-AM classification system. Results: The observer recorded the performance of 807 workload ‘events’, representing 28 separate types of activities. When compressed into the Pharmacy Activity Codes formerly used in the ICD-10-AM classification system, the pattern of activities identified by direct observation matched that which had previously been self-reported by pharmacists. The majority of the activities performed could be captured by completion of a Pharmaceutical Care Plan and by recording pharmacists’ interventions toa database. The remaining activities may be recorded for departmental workload purposes in a simple template format. Conclusion: The pattern of clinical pharmacist activity at the two hospitals was confirmed by direct observation as similar to that previously reported in other Australian hospitals. A Pharmaceutical Care Plan, a database for intervention recording and a simple workload template provide the means to record all activities that clinical pharmacists perform (AU)

El objetivo del estudio fue cuantificar la carga de trabajo de los farmacéuticos clínicos en Australia. Los objetivos específicos fueron realizar una observación directa de los modelos de actividades clínicas en dos hospitales de agudos y compararlas con los modelos que habían sido previamente autoreportados. También estábamos interesados en identificar que registros llevados los farmacéuticos podrían capturar todas sus actividades. Métodos: Un observador registraba las actividades de los farmacéuticos clínicos en seis días separados en los servicios de médicos y quirúrgicos de dos hospitales metropolitanos de Melbourne. Examinamos los datos resultantes para determinar registros adecuados con los que los farmacéuticos clínicos podrían registrar todas las actividades que realizaban. Para comparar los modelos de actividades clínicas con las auto-reportadas anteriormente, categorizamos los datos utilizando los Códigos de Actividad Farmacéutica (CAF) presentes en la penúltima versión del sistema de clasificación CDI-10-AM. Resultados: El observador registró las actividades de 807 eventos de trabajo, que representaron 28 tipos diferentes de actividades. Al comprimirlos en los CAF anteriormente usados en el sistema CDI-10-AM, los modelos de actividad identificados por observación directa se ajustaban a los que habían sido previamente auto-comunicados por los farmacéuticos. La mayoría de las actividades realizadas podía ser capturada en la cumplimentación de un plan de atención farmacéutica y en registrar las intervenciones del farmacéutico en una base de datos. El resto de las actividades puede registrarse para análisis de carga de trabajo del departamento en un modelo de formato simple. Conclusión: El modelo de la actividad de un farmacéutico clínico se confirmó por observación directa como similar a los previamente comunicado en otros hospitales australianos. Un plan de atención farmacéutica, una base de datos para registro de intervenciones y una simple hoja de registro de carga de trabajo proporcionan los medios de registro de todas las actividades que realizan los farmacéuticos clínicos (AU)

Identification by observation of clinical pharmacists' activities in a hospital inpatient setting.

UNLABELLED: The aim of the study was to quantify clinical pharmacists' workload in Australia. Specific objectives were to perform a direct observation of the pattern of clinical activities in two acute hospitals and compare that with previously documented self-reported patterns. We were also interested in identifying what records kept by pharmacists would capture all the activities they perform. METHODS: An observer recorded the activities of clinical pharmacists on six separate days in the medical and surgical wards of two Melbourne metropolitan hospitals. We examined resultant data to determine suitable records by which clinical pharmacists could capture all the activities they perform. To compare the observed pattern of clinical activities with those earlier self-reported by pharmacists, we categorised our data using the Pharmacy Activity Codes present in the penultimate version of the ICD-10-AM classification system. RESULTS: The observer recorded the performance of 807 workload 'events', representing 28 separate types of activities. When compressed into the Pharmacy Activity Codes formerly used in the ICD-10-AM classification system, the pattern of activities identified by direct observation matched that which had previously been self-reported by pharmacists. The majority of the activities performed could be captured by completion of a Pharmaceutical Care Plan and by recording pharmacists' interventions to a database. The remaining activities may be recorded for departmental workload purposes in a simple template format. CONCLUSION: The pattern of clinical pharmacist activity at the two hospitals was confirmed by direct observation as similar to that previously reported in other Australian hospitals. A Pharmaceutical Care Plan, a database for intervention recording and a simple workload template provide the means to record all activities that clinical pharmacists perform.