Table 4.

Description of adverse events identified by chart review

ADE description	Potentially preventable with the Seegnal platform	ADE severity
Intermittent delirium due to olanzapine and lorazepam while in ICU	Yes, using the most probable side effects mode	Serious
Excessive daytime somnolence and delirium due to multiple sedating medications (trazodone, haloperidol, quetiapine)	Yes, using the most probable side effects mode	Serious
Hyponatremia that improved after eslicarbazepine dose was lowered	Yes, this drug can cause hyponatremia, and the platform monitors patients’ laboratory results and would have recommended dose reduction when 1200 mg was first given	Significant
QTc on admission was 519 and went up to 614 after receiving ciprofloxacin and ondansetron	Yes, even though the MD received the DDI alert for ciprofloxacin and ondansetron, the platform would have alerted that QTc levels were already high when medication was ordered	Serious
Coagulopathy, most likely secondary to interaction between amiodarone and warfarin	Yes, even though the MD received the DDI alert for amiodarone and warfarin, the platform would have alerted once the patient's laboratory results started showing signs of coagulopathy	Serious
Increased tacrolimus levels due to DDI with voriconazole	Yes, even though the MD was aware of the DDI between tacrolimus and voriconazole, the platform would have alerted once tacrolimus levels started to increase	Significant
Decreased blood pressure to 84/44 and heart rate to 50s while receiving amlodipine, lisinopril, and metoprolol ER	Yes, by monitoring patient parameters and knowing the patient was on multiple medications that could decrease blood pressure and heart rate	Serious
Increased QTc for 5 days—had DDI alert for ciprofloxacin and tacrolimus	Yes, the platform would have identified all medications that increase QTc and alerted when QTc started to increase	Serious
Hypotension due to epidural	Yes, the platform would have alerted once the patient's blood pressure started to decrease	Serious
Bradycardia for 2 days due to propranolol	Yes, the platform would have alerted once the patient’s heart rate started decreasing	Serious
Increase QTc due to fluconazole; hypotension and mental status changes due to multiple medications	Yes, the platform can identify all medications that increase QTc and cause hypotension and mental status change and also alert based on the patient's specific parameters (QTc, blood pressure)	Serious
Contrast (Omnipaque)-induced nephropathy. Renal function was ok prior to receiving contrast	No, this ADE was not preventable because the patient’s renal status was ok prior to receiving the contrast	Serious
Severe chemotherapy-induced mucositis requiring TPN	No, this ADE was not preventable	Serious
Postoperative hypotension, thought to be a combination of hypovolemia and perioperative ACEI use	No, this ADE was not preventable, as it occurred during surgery. Patient was taken from the OR to the PACU then SICU in setting of postoperative hypotension requiring phenylephrine infusion	Life threatening
Naloxone needed after surgery	No, this ADE was not preventable; it occurred during surgery	Serious
Nausea due to oral KCL—admitted for hypokalemia with history of not tolerating oral KCL due to nausea and vomiting	Maybe; patient had a history of this ADE at admission, and the platform would have alerted if it was documented in a structured format instead of just notes	Significant

ACEI angiotensin-converting enzyme inhibitor, ADE adverse drug event, DDI drug–drug interaction, ER extended release, ICU intensive care unit, KCL potassium chloride, MD physician, OR operating room, PACU post-anesthesia care unit, QTc corrected QT interval, SICU surgical intensive care unit, TPN total parenteral nutrition