Go backSearch Session number: 1073

Abstract title: Utility of Nursing Narratives in ADE Detection: Incident Reports,Bedside Notes, and Electronic Notes

Author(s):
JF Hurdle - SLC VAMC GRECC and Univeristy of Utah
BS Roth - SLC VAMC GRECC
JR Nebeker - SLC VAMC GRECC and Univeristy of Utah
JM Hoffman - SLC VAMC GRECC
CR Weir - SLC VAMC GRECC and Univeristy of Utah

Objectives: Well-designed past assessments of VHA-wide adverse drug events (ADEs) noted that 67% of facilities relied on spontaneous reporting of ADEs by clinical staff. Nursing staff are uniquely situated to detect ADEs, so our objective was to further research in this area by quantifying the relative utility of three kinds of nursing narratives as signals for ADEs: incident reports (IRs), Bedside Notes (BNs), and Electronic Progress Notes (EPNs).

Methods: Clinical pharmacists experienced in ADE surveillance reviewed narratives as follows: 1) they screened IRs (we printed/reviewed all IRs entered during the study period, 2306 total admissions; IRs suggesting an ADE were corroborated by an MD); 2) they screened all EPN on randomly selected admissions (937 admissions, as part of the original, larger study using several methods to detect ADEs); and 3) they screened BNs (we selected 303 patient records from the original study and reviewed all handwritten nursing notes, e.g., on flow sheets, on the MAR, etc.).

Results: Nurses filed 179 IRs during the study period of which 19 (10.6% ) described a certain/probable ADE. Sixteen were not detected in the original study. These IR ADEs would have contributed 3% more to the original study. In EPNs, electronic nursing notes identified 73 ADEs (14% of original total). In handwritten BNs we discovered a significant number of ADEs. Of the 303 charts, we detected/classified 163 additional ADEs suffered by 88 patients (29.0% had one or more ADEs), reasonably close to the original study’s patient rate (41.1%). If IRs and BNs (weighted) were added to the original study, nursing narratives could have signaled 39.3% of all ADEs.

Conclusions: Incident reports are a poor source of ADE-related narrative, whereas bedside nursing notations are a rich source of ADE information not typically included in ADE surveillance. The common-sense notion that nurses are well poised to detect ADEs is confirmed, but their most significant observations are largely hidden from mainstream review and surveillance.

Impact statement: A rich but undervalued source for ADE surveillance data exists in the nursing bedside note. Increased attention to bedside notes promises to improve not only ADE prevention, but general clinical efficiency as well.