Hospital Drug Monitoring

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Chapter: Pharmacovigilance: Keynote Clinical Lessons from Pharmacovigilance

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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