A Point-of-Prescription Safety-Check System for Adverse Drug Reactions in Rural Bangladeshi Hospitals: A Feasibility Study

Abstract

Adverse drug reactions (ADRs) are a major, largely preventable source of patient harm. In high-income settings, electronic health records store a patient's allergy history and warn prescribers when a contraindicated drug is ordered; in rural Bangladeshi public hospitals no such record exists for outgoing patients, a single physician may see on the order of one patient per minute, and a patient's history of severe reactions does not survive between visits. This paper proposes and outlines the evaluation of a lightweight, smartphone-based safety-check system for this setting. At registration a soft identifier (a phone number) is recorded; after the physician writes a prescription, its image is captured, the brand names are resolved to active ingredients using national drug references, and the ingredients are matched against the patient's recorded severe reaction history. The system is retrieval-based rather than predictive, and is silent by default, raising a flag only for high-risk matches a design grounded in the alert-fatigue literature. We frame the work as a feasibility study: we describe the proposed framework and an evaluation plan measuring workflow fit under high volume, usability, identity-resolution reliability, and retrospective detection of known reaction cases. We explicitly do not claim a clinical-outcome effect, which the low base rate of severe events places beyond a single-site feasibility study.