The Assessment Tool for Hospital Admissions Related to Medications (AT-HARM10) was developed and validated as a part of the MedBridge project. It is a practical tool consisting of ten yes-no questions to distinguish between hospital admissions that are unlikely to be and those that are possibly drug-related.
The first version of AT-HARM10 (published in 2018) was developed to identify possible drug-related admissions and validated for use in older patients by a pair of final-year undergraduate and postgraduate pharmacy students. The applicability and reliability to identify possible drug-related emergency department visits with AT-HARM10 was confirmed in a recent study, published in 2022. As a consequence, the tool and its instructions have been updated to support its novel use in clinical research.
- The first validation study (link.springer.com)
- The second validation study (link.springer.com)
- The updated version of AT-HARM10 (Supplementary Information) (link.springer.com)
The second study and updated version of the tool
Answer questions with yes or no until the answer is yes. The order the questions are answered is not important.
If the answer to any of the first three questions is yes, the admission or emergency department visit is unlikely to be medication related.
If the answer to any of the last 7 questions is yes, the admission or emergency department visit is possibly medication related.
- Was the admission caused by an infection, a previously undiagnosed disease (e.g., diabetes or heart failure), or symptoms, signs and abnormal clinical and laboratory findings (if no specific diagnosis has been made) that do not seem to be drug-related?
- Was the admission caused by progression of a previously diagnosed disease that is not drug-related?
- Was the admission caused by physical trauma, substance intoxication, social circumstances or allergies (e.g., car accident, alcohol, mushroom poisoning, wasp allergy) that was/were not drug-related?
- Is it hinted or stated in the medical records that the admission was drugrelated (including non-compliance)?
- Might (side) effects of the medications the patient was taking (prescribed or non-prescribed) prior to hospitalisation have caused the admission (including over-treatment)?
- Are there abnormal laboratory results or vital signs that could be drugrelated and might have caused the admission?
- Was there any drug-drug interaction or drug-disease interaction (i.e., a contraindication) that might have caused the admission?
- Did the patient have any previously diagnosed, untreated or sub-optimally treated (e.g., dose too low) indications that might have caused the admission?
- Was the patient admitted because of a problem with the dosage form or pharmaceutical formulation (e.g., failure to receive the medication)?
- Is the cause of the admission a response to cessation or withdrawal of medication treatment?