Signals to Detect Potential Adverse Drug Reactions

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Many adverse drug reactions (ADRs) have signals that can be used to reduce risks to nursing home patients.

Some of the laboratory and medication combination signals for detecting ADRs in nursing homes include:

  • Hypoglycemia in a patient receiving a drug know to lower blood glucose (oral hypoglycemic or insulin)
  • Supratherapeutic INR in a patient on warfarin therapy
  • Diff infection in a patient on high dose PPI (i.e. omeprazole)
  • Hyperkalemia in a patient on potassium supplement and/or spironolactone
  • Elevated BUN in a patient on an NSAID (i.e. ibuprofen, naproxyn) especially if the patient is also on fluid restriction or is dehydrated

Some of the Antidote Signals include

  • Vitamin K use in a patient on warfarin
  • Glucagon or liquid glucose in a patient on insulin or oral hypoglycemic
  • Oral vancomycin or metronidazole in a patient on high-dose PPI
  • Sodium polystyrene (Kayexalate) in a patient on potassium supplement and/or spironolactone

Your AlixaRx clinical pharmacist monitors for these ADR signals as part of their monthly medication regiment review (MRR).    The pharmacist can also alert you if they are seeing multiple signals for the same drug across multiple patients.  This is an opportunity to discuss these signals at the QAPI meeting with your medical director to see if a medication performance improvement project (PIP) can be implemented to improve drug prescribing and patient outcomes.


Reference: Consensus List of Signals to Detect Potential Adverse Drug Reactions in Nursing Homes JAGS    56:808–815, 2008

This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.

>>> From the Front Lines – June 2015 <<<