Sharing data about ADEs reduces repeat events

VANCOUVER – Researchers at Simon Fraser University and the University of British Columbia are working to reduce adverse drug events (ADEs), the harmful and unintended consequences of medication that send two million Canadians to visit emergency departments every year. They’ve created software called ActionADE to document ADES and communicate with pharmacies to help prevent re-dispensing drugs that have led to patient harm.

SFU professor Ellen Balka (pictured) and UBC professor Corinne Hohl spent a decade of research on developing the technology, including extensive privacy and ethics reviews and pilot testing. ActionADE is now being implemented in nine Lower Mainland hospitals with more sites to come.

Balka, a professor in SFU’s School of Communication and Hohl, an associate professor in UBC’s Department of Emergency Medicine, and emergency department physician, conceived ActionADE while collaborating on ways to improve information sharing in B.C.’s healthcare system. The research has been based at Vancouver General Hospital’s Centre for Clinical Epidemiology and Evaluation Studies.

“In medication safety, people have focused their attention on other problems,” says Balka. “For example, preventing drug-to-drug interactions or getting the right medication to the right person in a hospital by barcoding medications. It turns out that those interventions are only responsible for preventing a very small proportion of adverse drug events.”

Despite the recent federal Protecting Canadians from Unsafe Drugs Act (also known as Vanessa’s Law), which mandates serious adverse drug reaction reporting, the researchers say that less than 5 percent of these reactions are being reported.

Hohl’s research found that at least one-third of ADEs are repeat events that occur when an ADE is documented at the hospital, but that information isn’t shared with the prescriber or pharmacies, resulting in a preventable, repeat ADE.

“The implementation of this software into clinical care here in B.C. represents a tremendous step forward, helping to improve communication and ultimately reduce adverse drug events for patients,” says Hohl.

Researchers collaborated with healthcare professionals, government, and patients and studied how healthcare workers use existing databases. SFU engineering alumnus Colin Quon led the software development.

The researchers’ main challenge was to ensure that ActionADE software would be compatible and integrate with multiple health authorities’ myriad software systems and databases, while also integrating with PharmaNet, the network that connects all B.C. pharmacies to a central data system and includes information about all dispensed prescriptions.

“This work is really impactful, as we’ve managed to change provincial and health authority computer systems to improve research data collection, as well as quality of care,” says Balka,

“We’re the first group that has managed to influence the direction of PharmaNet. Before this, the only data getting pushed to PharmaNet from acute care sites was medication and billing data, and, occasionally, information about a drug allergy from community pharmacists. Now we’ve created a mechanism for a two-way flow of ADE information between hospital sites and PharmaNet.”

A randomized control trial was recently launched by the researchers to assess improved health outcomes and associated cost savings resulting from prevention of repeat ADEs.

In addition to its use in hospitals, two pharmacy software providers with significant market share in BC have altered their software to display ADE information they receive through PharmaNet, and a third system is expected to follow shortly.

“It takes very little time to document an adverse drug event,” says Balka, “and as a result of this software, the number of documented adverse drug events has gone up. You can’t prevent them if you’re not documenting them.”

Funding from the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research, Vancouver Coastal Health and BC’s Ministry of Health has supported the research.