Table 1.
Trigger list used to assist in identifying potential adverse drug reactions
| Category | Trigger |
|---|---|
| Use of these drugs (antidotes) suggests a potential ADR occurred | Naloxone |
| Methadone | |
| Flumazenil | |
| Digoxin immune fab (“Digibind”) | |
| Protamine sulphate | |
| Activated charcoal | |
| Biperiden / promethazine / diazepam | |
| Sodium polystyrene (“Kayexalate”) | |
| Insulin with glucose | |
| Calcium gluconate | |
| Dextrose 10% | |
| Adrenaline (epinephrine) | |
| Systemic corticosteroid | |
| Diphenhydramine, prochlorperazine, promethazine, or any new antihistamine | |
| Antiemetics | |
| Oral vancomycin | |
| Granulocyte colony-stimulating factor | |
| Supratherapeutic drug concentration suggests a potential ADR occurred | Digoxin > 1.5 nmol/L |
| Theophylline > 110 μmol/L | |
| Lidocaine > 5 μg/L | |
| Phenytoin > 80 μmol/L | |
| Carbamazepine > 51 μmol/L | |
| Phenobarbital > 172 μmol/L | |
| Valproic acid > 700 μmol/L | |
| Gentamicin or tobramycin peak > 10 mg/L or 24 h trough > 2 mg/L | |
| Amikacin peak > 30 mg/L or 24 h trough > 2 mg/L | |
| Vancomycin trough > 25 mg/L or > 30 mg/L during continuous infusion | |
| Any other drug concentration reported as supratherapeutic | |
| Paracetamol concentration done (regardless of result) | |
| Laboratory result (other than TDM) suggests a potential ADR occurred | Partial thromboplastin time (PTT) > 100 s |
| International normalised ratio (INR) > 5 | |
| Anti-factor Xa ≥ 1.5 IU/mL | |
| Platelet count < 50 × 109/L | |
| White cell count < 3 × 109/L | |
| Haemoglobin < 8 g/dL | |
| Pancytopaenia | |
| Clostridium difficile positive stool after exposure to antibiotics | |
| Creatinine rising to above-normal range | |
| Hyponatraemia or Hypernatraemia | |
| Potassium < 3.5 mmol/L, in the absence of diarrhoea | |
| Potassium > 5.5 mmol/L | |
| Alanine transaminase (ALT) > three times upper limit of normal (ULN = 40 IU/L) in the presence of negative viral hepatitis screening test results | |
| Bilirubin > two times upper limit of normal (ULN = 21 μmol/L); if in a neonate, the neonate should also be on drugs | |
| Serum glucose < 3 mmol/L, outside the perinatal period | |
| Hyperlactataemia on antiretroviral therapy | |
| Clinical event suggests a potential ADR occurred | Angioedema or lip swelling |
| Rash or ulceration | |
| Mucositis or mucosal ulceration | |
| Pruritus | |
| Sudden onset wheezing | |
| Jaundice, new onset | |
| Dystonia, ataxia, torticollis, dyskinesia | |
| Retinopathy in premature infant on oxygen | |
| Hearing disturbance or hearing loss | |
| Seizure(s) | |
| Oversedation, lethargy, falls | |
| Decreased level of consciousness or pressure sores | |
| Delirium | |
| Fracture or osteoporosis | |
| Upper gastrointestinal bleed | |
| Arrhythmia, new | |
| Hypertension | |
| Nausea reported by parents / documented in file | |
| Constipation | |
| Biopsy of bone marrow, kidney, or liver | |
| Withdrawal symptoms | |
| Any other event suspected to be drug-related by doctor or nurse | |
| Unexplained medication stop | |
| Readmission to acute care unit within 14 days of discharge | |
| Readmission to intensive care unit within 48 h of transfer or discharge | |
| Require resuscitation in ward | |
| Death |