The Adverse Drug Reaction Profile

The Challenge

Insufficient patient monitoring for the adverse effects of medicines is an important cause of harm to patients. In all age groups, preventable adverse effects of medicines often pass unnoticed, but lead to real harm.

Poor medicines management, including over and under prescribing, would be significantly more preventable with additional targeted and formalised patient monitoring, particularly in care homes. 

The Adverse Drug Reaction (ADRe) Profile identifies and addresses the adverse effects that medicines can have on patients, preventing people being left in pain, sedated, confused, aggressive or breathless.

ADRe is a structured monitoring system that helps nurses or carers check patients for the known adverse side effects of their medicines. ADRe is evidence-based, being effective in trials: it reduced prescribing of medicines and improved symptoms, including pain.

ADRe also prevents problems becoming so serious that hospital admission is needed. It helps most patients who use it, some more so than others.

Professor Sue Jordan led the studies, which showed how adverse side effects were picked up more effectively by nurses and carers when ADRe was used alongside administration of medicines. Studies were conducted in care homes and across community mental health teams.

The Impact

To date, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews by pharmacists or prescribers.

The studies showed that ADRe:

• prevented serious drug reactions in approximately 10% of patients;
• led to better quality of care;
• led to better recognition of pain, breathlessness, sedation, infections, problems with vision, poor food intake and constipation, and better oral care;
• led to a reduction in prescribing medicines: residents were ‘brighter’, less agitated, or less aggressive when care changed to reduce antipsychotic medicine.

Demonstrates:

• dignity in care (NMC 2015 p.4);
• clinical governance = continuously improving + safeguarding high standards.

Potential cost savings:

• Nurses’ or assistants’ time to administer the Profile: 10-25 minutes, ~£20;
• £2000 = estimated treatment cost of a serious ADR.

Meeting the WHO 3rd Global Patient Safety Challenge in Medication Safety:

• medicines sometimes cause serious harm if … monitored insufficiently;
• addresses the Andrews’ Report, Older People’s commissioner (2014, 2018), Use of Antispcyhotics in Care Homes (WG 2018).