Background There is currently no standardised method for determining avoidability of adverse drug reactions (ADRs) and many of the established tools are not suitable for use in paediatrics. We have developed a new tool; the Liverpool ADR avoidability assessment tool (LAAT). Initial testing showed mixed inter-rater reliability.
Aim To test the hypothesis that group assessments are superior to individual avoidability assessments.
Methods Participants were assigned either to a consensus group or to individually assess avoidability for a purposive sample of 20 ADR cases. Individual participants (nurses, pharmacists and doctors) independently assessed the cases. Groups took part in multidisciplinary meetings to assess the cases and reach consensus. The results were compared to the ‘gold standard’ (the avoidability outcome set by a panel of senior investigators). An ethnographic approach was taken; the consensus meetings were overseen by a facilitator and non-participant observations of the meetings were recorded. Post consensus meeting semi-structured interviews were conducted with the group members. Qualitative and quantitative analyses were carried out. We examined the extent to which individuals and groups agreed with the ‘gold standard’ using percentage exact agreement (%EA) (Figure 1).
Results Agreement ranged from 35–70%. The mean agreement for individuals was 54% and 47% for the consensus groups.
Conclusion In assessing avoidability of ADRs individual assessments had better agreement with the ‘gold standard’ evaluation than group assessments. Qualitative analysis of meeting observations and participant interviews may help identify reasons for this and inform the optimisation of the LAAT for assessment of ADR avoidability.