Drug safety monitoring started with detailed studies of suspected adverse drug effects in hospitalised patients.
HOSPITAL DRUG MONITORING
Drug
safety monitoring started with detailed studies of suspected adverse drug
effects in hospitalised patients. Recently, most pharmacovigilance work of an
observational nature has been confined to commu-nity practice, because the
number of drugs used and the number of underlying conditions experienced by
patients are generally fewer there than in hospitals. This leads to easier
interpretation of data but does leave a gap in our knowledge of the safety of
drugs whose use is confined to the hospital setting, such as anaesthetics and
third-line antibiotics. There will need to be some efforts directed from time
to time towards correcting these omissions, probably by ad hoc stud-ies in hospitals such as have been undertaken by the
Boston Collaborative Drug Surveillance Program in the 1970s and 1980s, the
Medicines Evaluation and Monitoring Group in Dundee and more recently by
Pirmohamed and colleagues (BMJ 2004; 329: 15–19).
Such
studies would be greatly facilitated by more widespread use of computerised
prescribing systems in hospitals. The research potential of this type of system
would be further enhanced if such systems were linked directly with patients’
general practice records. This is entirely practicable if the will, finance and
issues of patient confidentiality can be resolved. Such efforts, if associated
with real-time feedback, could also be used to monitor standards of prescribing
in target areas of concern.
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