Background: Adverse drug reactions (ADRs) pose a significant burden on patients and the health system. ADR reporting contributes to data that guide patient safety strategies. Despite numerous strategies aimed to improve ADR reporting rates, ADRs continue to be under-reported. Aim: To compare the effectiveness and efficiency of identifying institutional ADRs using the International Classification of Diseases 10th Revision Australian Modification (ICD-10-AM) clinical coding surveillance and spontaneous reporting. Method: Medical records of multi-day (staying overnight or longer) inpatient separations (single patient encounter resulting in discharge) assigned an ADR-related ICD-10-AM code were retrospectively reviewed to verify if an ADR had occurred and whether the codes assigned were appropriate. ADR reports received via the spontaneous reporting system were also reviewed. ADRs were assessed for causality, seriousness and type of reaction. The drugs, type of adverse reactions involved and the resource implications of this reporting method were also investigated. Results: ICD-10-AM coding surveillance and spontaneous reporting resulted in an ADR reporting rate of 3.3% and 0.4% of inpatient separations, respectively. ICD-10-AM coding surveillance was more likely to identify type A ADRs than spontaneous reports although there were no significant differences in seriousness or causality. The ICD-10-AM codes assigned were appropriate in 94% of cases, with the omission of drugs being the most common discrepancy. Conclusion:The ICD-10-AM coding surveillance is an effective and efficient method of improving ADR reporting by utilising data collected for administrative purposes.

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Background: The Monash Health Hospital Outreach Medication Review (HOMR) service is a pharmacist-led service that targets patients at high risk of medication misadventure in the immediate post-discharge period. Aim: To study the impact of a HOMR service on emergency department attendances and hospital admissions within an Australian hospital network. Method: Information was collected on the total number of emergency department attendances and hospital admissions during the 12-month period prior to, and after, the date a HOMR service was provided to the study group between 1 January 2012 and 22 November 2012. This was compared to a control group who were referred to the service and were eligible, but rejected the service. Patients were stratified by age (≤50, 51-65 and >65 years) to determine any age-related variations and tõhen investigated excluding regular, planned admissions (dialysis, chemotherapy or transfusion-related). Results: The 398 patients in the study group had a total of 1691 admissions in the 12-month period pre-HOMR. The total number of admissions in the 12-month period post-HOMR was higher than during the pre-HOMR period for both the control and study groups. When an age subanalysis was conducted and regular planned admissions were excluded, patients aged 51-65 years exhibited a 25% reduction in hospital admissions (v 2 = 6.14, p < 0.05). There was no significant reduction in admissions for the other age groups or in emergency department attendances. Conclusion: The provision of HOMR outreach services has a valuable role to play in a clearly identified population that is at high risk of medication misadventure.

We found no significant difference in pain score reductions between the two groups but some level of therapeutic benefit is not excluded.