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Consensus list of signals to detect potential adverse drug reactions in nursing homes.

ABSTRACT: To develop a consensus list of agreed-upon laboratory, pharmacy, and Minimum Data Set signals that a computer system can use in the nursing home to detect potential adverse drug reactions (ADRs).Literature search for potential ADR signals, followed by an internet-based, a two-round, modified Delphi survey.A nationally representative survey of experts in geriatrics.Panel of 13 physicians, 10 pharmacists, and 13 advanced practitioners.Mean score and 95% confidence interval (CI) for each of 80 signals rated on a 5-point Likert scale (5=strong agreement with likelihood of indicating potential ADRs). Consensus agreement indicated by a lower-limit 95% CI of 4.0 or greater.Panelists reached consensus agreement on 40 signals: 15 laboratory and medication combinations, 12 medication concentrations, 10 antidotes, and three Resident Assessment Protocols (RAPs). Highest consensus scores (4.6, 95% CI=4.4-4.9 or 4.4-4.8) were for naloxone when taking opioid analgesics; phytonadione when taking warfarin; dextrose, glucagon, or liquid glucose when taking hypoglycemic agents; medication-induced hypoglycemia; supratherapeutic international normalized ratio when taking warfarin; and triggering the Falls RAP when taking certain medications.A multidisciplinary expert panel was able to reach consensus agreement on a list of signals to detect potential ADRs in nursing home residents. The results of this study can be used to prioritize an initial list of signals to be included in paper- or computer-based methods for potential ADR detection.

SUBMITTER: Handler SM

PROVIDER: S-EPMC2695658 | biostudies-literature | 2008 May

REPOSITORIES: biostudies-literature

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Consensus list of signals to detect potential adverse drug reactions in nursing homes.

Handler Steven M SM Hanlon Joseph T JT Perera Subashan S Roumani Yazan F YF Nace David A DA Fridsma Douglas B DB Saul Melissa I MI Castle Nicholas G NG Studenski Stephanie A SA

Journal of the American Geriatrics Society 20080321 5

<h4>Objectives</h4>To develop a consensus list of agreed-upon laboratory, pharmacy, and Minimum Data Set signals that a computer system can use in the nursing home to detect potential adverse drug reactions (ADRs).<h4>Design</h4>Literature search for potential ADR signals, followed by an internet-based, a two-round, modified Delphi survey.<h4>Setting</h4>A nationally representative survey of experts in geriatrics.<h4>Participants</h4>Panel of 13 physicians, 10 pharmacists, and 13 advanced practi ...[more]

PMID: 18363678

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Project description:Anaplastic lymphoma kinase (ALK) rearrangements occur in ∼3%-6% of patients with advanced non-small-cell lung cancer (NSCLC). Small molecular drugs that effectively inhibit ALK gene have revolutionized the therapeutic paradigm for patients with ALK rearrangements, resulting in significant improvements in objective response rate, progression-free survival, and overall survival compared with classical platinum-based chemotherapy. Several ALK tyrosine kinase inhibitors (ALK-TKIs), including crizotinib, alectinib, ceritinib, brigatinib, ensartinib, and lorlatinib, have been recommended as standard first-line treatment for advanced NSCLC patients with ALK rearrangements. Patients with ALK rearrangements typically exhibit long-term durable responses to ALK-TKIs; therefore, the management of adverse drug reactions (ADRs) with ALK-TKIs is crucial in clinical practice to maximize clinical benefits, prevent an adverse impact on quality of life, and improve patient compliance. In general, ALK-TKIs are well tolerated. There are, however, a number of serious toxicities that may necessitate dose modification or even discontinuation of treatment and the management of ADRs with ALK-TKIs has grown in importance. The therapeutic use of this class of medications still carries some risk because there are currently no pertinent guidelines or consensus recommendations for managing ADRs caused by ALK-TKIs in China. In order to improve the clinical management of ADRs with ALK-TKIs, the Chinese Society of Clinical Oncology (CSCO) Non-small Cell Lung Cancer Professional Committee led the discussion and summary of the incidence, diagnosis and grading standards, and prevention and treatment of ADRs caused by ALK-TKIs. Highlights • Though ALK-TKIs are well tolerated, certain toxicities may necessitate dosage adjustments or treatment cessation.• The management of ADRs with ALK-TKIs has grown in importance.• The CSCO NSCLC Professional Committee led the expert consensus of management of ADRs with ALK-TKIs.• The current consensus can help in improving the clinical management of ADRs with ALK-TKIs.

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Dataset Information

Consensus list of signals to detect potential adverse drug reactions in nursing homes.

Publications

Consensus list of signals to detect potential adverse drug reactions in nursing homes.

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