The full content of Annals is available to subscribers

Subscribe/Learn More  >
Improving Patient Care |

Clarifying Adverse Drug Events: A Clinician's Guide to Terminology, Documentation, and Reporting

Jonathan R. Nebeker, MS, MD; Paul Barach, MD, MPH; and Matthew H. Samore, MD
[+] Article, Author, and Disclosure Information

From Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, Utah; and Jackson Memorial Hospital, University of Miami, Miami, Florida.

Ann Intern Med. 2004;140(10):795-801. doi:10.7326/0003-4819-140-10-200405180-00017
Text Size: A A A

Since the early 1990s, adverse drug events have received significant attention from researchers in quality and patient safety (1). Nationally recognized quality experts have identified adverse drug events as a top safety priority (2) because these events are the most common type of iatrogenic injury (3). Studies have indicated that adverse drug events occur almost daily in medium-sized hospitals and outpatient panels (46). However, despite the high morbidity and mortality, physicians often do not recognize or appropriately treat instances of drug-related harm (78).

First Page Preview

View Large
First page PDF preview


Grahic Jump Location
Relationships of key terms.

The gray areas represent injuries caused by drug use (adverse drug events). The dark gray area represents harm caused by a drug (adverse drug reactions). The light gray area represents harm from appropriate drug use that is generally excluded from studies of adverse drug events. Medication errors are much more common than adverse drug events, but they result in harm less than 1% of the time (30). Conversely, about one quarter of adverse drug events are due to medication errors(4).

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Farewell to ARMs
Posted on May 22, 2004
Sonal singh
Unity health System,Rochester,NY14626
Conflict of Interest: None Declared

Dr Nebeker and his colleagues attempt to clarify the confusion surrounding the terminology of adverse drug reactions (ADRs) and adverse drug events is commendable but raises several interesting questions (1).

Firstly, the authors fail to mention whether their proposed terminology of adverse drug events extends to adverse events occurring with herbal medications and supplements, which have become increasingly common today.

Secondly, the term "drug" excludes contaminants (such as in herbal medicines) or inactive substances in a formulation (2). So should we be talking about adverse reactions to medicines, ARMs rather than adverse drug reactions (ADRs) (2)?

Clarifying the terminology surrounding adverse events will enable both clinicians and patients bid farewell to ARMs.


1. Nebeker, J. R., P. Barach, et al. (2004). "Clarifying Adverse Drug Events: A Clinician's Guide to Terminology, Documentation, and Reporting." Ann Intern Med 140(10): 795-801.

2. Aronson, J. (2004). "HARMful reactions." BMJ 328(7449): 1173-.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.