Here are a list of frequently asked questions regarding the Adverse Drug Reaction Profile.
What are the advantages of using the ADRe Profile?
The ADRe Profile ensures that patients’ health is reviewed against their medication plan to ensure there are no unnoticed adverse reactions or preventable adverse events. Research has shown that by using this instrument benefits all patients and enhances care is several different ways. For example, improved oral care to counter the dry mouth caused by mental health medicines, vision checks to detect any blurring of vision caused by some medicines, etc.
Are adverse drug reactions a serious problem?
Yes, preventable adverse drug reactions occur in approximately 8% of patients in the community, and can include potentially life-threatening problems, such as irregular heart rhythm. Adverse drug reactions are responsible for 5-8% of UK unplanned hospital admissions and cost the NHS £1 to 2.5 billion each year.
Nurses have a lot of paperwork, and some teams are resistant to extra paperwork. Isn’t this just another form to fill in?
ADRe brings together relevant information from several forms, such as records of vital signs, pain, eating and drinking, activities of daily living. The accompanying guidelines help to relate these to prescribed medicines. If the ADRe Profile is completed, several other forms may not be needed.
Will anybody look at this if I complete it?
ADRe Profiles should be shared with prescribers and pharmacists reviewing medicines, as part of multidisciplinary team working. By bringing all the information onto one page, together with the list of prescribed medicines , it makes it easier to see if any problems might be caused or exacerbated by the prescriptions being reviewed.
Isn’t all the information in other documents?
Some information is in other documents, but it isn’t always easy to find. It can take over an hour to locate the necessary information in patients’ notes, and prescribers do not always have this time.
How long does it take to complete the Profile with the patient?
10-25 minutes, including measuring vital signs.
Most patients do not want to answer questions for 15-20 minutes.
All participants in our studies have positively welcomed the extra attention being given to their health. However where time is an issue ADRe can be completed over a series of sessions.
How often would the ADRe Profile be needed?
It is recommended that ADRe is completed:
- Before scheduled medication reviews and consultant appointments
- Before a mental health medicine is started
- 24-48 hours, 1 week and 1 month after a mental health medicine is started
- Regularly, every 4-8 weeks
Repeated use of ADRe allows clinicians to follow progress when changes are made. It helps clinicians to become familiar with a single format of documentation, rather than switch between profiles.
Is this work covered by existing guidelines?
The use of ADRe helps ensure compliance with:
- Medicines’ Optimisation G5 2015 (recommendation 27)
- Managing Medicines in care homes SC1 2014 (recommendation 1.8)
- Psychosis and Schizophrenia in adults: treatment and management CG178 2014 (recommendations 1.1 and 1.3),
- Recommendations of the Francis Report on inappropriate sedation, recording and adverse effects, Recommendations of the Older People’s Commissioner on the need for medication reviews.
- Ensuring that treatment does no harm is an important aspect of ethical practice (cf Hippocratic corpus 1923).
Why use ADRe over existing instruments to capture adverse side-effects?
ADRe is the most comprehensive instrument currently available to healthcare staff to help them identify and address adverse drug reactions to the full range of mental health medicines.
All mental health medicines are included in one profile. Why?
As there is considerable overlap of the adverse effects of these medicines it is essential all the information is recorded in one form. The accompanying guidelines then indicate which medicines are likely to cause each problem. In practice, many of these medicines are co-prescribed, or one is substituted for another.
Is ADRe only for elderly people/care homes?
No, adverse drug reactions can happen at any age. Work has been done with mental health teams (Jordan 2002, Jones et al 2016), and in hospital outpatients (Gabe et al 2015), with service-users across the age range. We are now exploring the role of ADRe in general practice.
Does ADRe provide a score?
No, each problem should be reviewed and considered on its own merit. There would be no reason to assume that multiple problems would be related.
Checking patients for any adverse effects of prescribed medicines sounds an obvious thing to do.
In practice, our research shows that taking time to use the ADRe Profiles demonstrates a considerable improvement to the quality of care that a patient will receive. We hope this will become routine practice.