Despite of the fundamental importance of reporting of suspected adverse drug reactions (ADR) for more safe and proper use of medicines, the ADR was under-reported by the medical practitionals (doctors, pharmacists, nurses) in a tertiary hospital. This study was performed to estimate the actual ADR occurrence, and to find out the methods to encourage ADR monitoring in a tertiary hospital. The charts marked ICD-10 code (International Classification of Disease, 10th revision) meaning the ADR were selected by searching the computerized medical records among all charts of patients who were admitted between January 1998 and January 2001. Among 91,592 records of inpatients, only 119 charts (0.13%) had records of ADRs and this percentage was very lower than found in other studies. Of 119 ADR marked charts, ADR was a major cause of admission for 51.3% and the medical department with the highest frequency of ADR was Internal Medicines (52.1%). The most common medicine inducing ADR was corticosteroids (29.4%) and major ADR manifestations were gastrointestinal discomforts. A questionnaire seeking reasons for non-reporting was sent to medical practitionals in object hospital. 179 (43%) questionnaires were returned and the response rate of doctors (26.5%) was very lower than others (nurses 79.6%, pharmacists 74.3%). 72.1% of respondent unknew current ADR monitoring system, but 96.6% were aware of the need to education and information about ADR monitoring. About the methods to educate or inform the ADR monitoring, the rate of preference was similar among the suggested methods, e.g. monthly conference or regular education, informed by circular notice paper, informed by e-mail or bulletin board, use the drug information newsletter of pharmacy department. The most important reasons for unreporting ADR were unknown of how to report ADRs (29.3%), uncertainty as to which medicine caused the ADR (24.8%).
In conclusion, the measures to improve current ADR monitoring could be educational programs including direct mailing and presentations combined with a convenient reporting system and feed-back to physicians. With such methods there would be improvement in the number and quality of ADR reports.
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