Targeting Outpatient Drug Safety Recommendations of the Dutch HARM-Wrestling Task Force Margaretha F. Warle ´-van Herwaarden, 1 Cees Kramers, 2 Miriam C. Sturkenboom, 3 Patricia M.L.A. van den Bemt 4,5 and Peter A.G.M. De Smet 1 1 IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 2 Department of Pharmacology and Toxicology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 3 Pharmacoepidemiology Unit, Department of Medical Informatics and Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands 4 Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands 5 Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands Abstract Background: Two Dutch observational studies (HARM [Hospital Admissions Related to Medication] and IPCI [Integrated Primary Care Information]) have shown that approximately 5% of all unplanned hospital admissions are asso- ciated with adverse drug events (ADEs), of which 40–46% are potentially preventable. These studies prompted the initiation of a Dutch multidisciplinary task force, which was assigned to reduce the number of prescriber-related hospital admissions related to medications (HARMs) in a quick-win way. Objective: The aim of the study was to identify the most relevant ADEs and to develop a limited number of recommendations for concrete interventions, which should be feasible and relatively easy to convert into computerized drug safety alerts. Method: To identify the major ADEs, crude data of HARM and IPCI were reanalysed and compared with different international studies, followed by structured literature searches for further characterization of the identified ADEs, their risk factors and potential risk-reduction strategies. Based on this information, the Task Force drew up general and drug-specific recommenda- tions. As the recommendations of the Task Force are a mixture of evidence- and expert-based risk-reducing strategies, they have been graded in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Results: Seven pharmacologically predictable ADEs associated with ten drug classes were responsible for more than half of all potentially preventable hospital admissions in the IPCI and HARM studies, which was comparable to the results of international studies. Gastrointestinal and other bleedings were the most frequent ADE, followed by disturbances of diabetes mellitus ORIGINAL RESEARCH ARTICLE Drug Saf 2012; 35 (3): 245-259 0114-5916/12/0003-0245/$49.95/0 ª 2012 Adis Data Information BV. All rights reserved.