BACKGROUND: Standard monitoring procedures and analysis methods for suspected adverse drug reactions (ADRs) within the electronic health record (EHR) consist of hospital staff reporting and review of International Classification of Diseases, Tenth Revision, Clinical Modification codes. Literature regarding ADR monitoring suggests that these methodologies may underreport incidence rates and limit quality improvement efforts. In response, we hypothesize that a more automated way of identifying ADRs, performing analyses, and uncovering opportunities for improvement with oncologic therapies exists within the broad landscape of readily available EHR data within an infusion center. OBJECTIVES: The primary objective is to quantify the number of suspected ADRs identified in the alternative method. The secondary objectives are to identify the patterns and types of suspected ADRs reported and to identify opportunities for the improvement of quality patient care. METHODS: A sample of data collected from the EHR between January 1, 2020, and December 31, 2020, was reviewed to validate patients who met the study's inclusion criteria, including being an active infusion center patient at Sibley Memorial Hospital (SMH), having an order for chemotherapy or a biologic agent, and having treatment note modifications as a result of a suspected ADR. Standardized reports were completed for a representative sample of the eligible patients for the estimation of the annualized ADRs and comparison with methods historically used for ADR reporting within the institution. RESULTS: A total of 331 treatment note modifications met the first and second study inclusion criteria. To address the workload requirements within the study period, we used a targeted approach where 88 entries were further reviewed until 20 (22.7%) confirmed ADR records were identified, none of which were previously reported. Of the 20 confirmed ADRs, 19 (95%) were categorized as predictable and 1 (5%) was unpredictable. One (5%) ADR was mild, 11 (55%) were moderate, and 8 (40%) were severe. One ADR (5%) was highly probable, 13 (65%) were probable, 5 (25%) were possible, and 1 (5%) was remote in causality. In all, 11 patients had a resolution of their ADR symptoms. A total of 7 patients did not have symptom resolution and 2 patients died. The opportunities for the improvement of quality care include reducing the time to fill out the SMH ADR antineoplastic form, improving clinical documentation in the treatment note modification, consistently documenting oncology drug allergies and intolerances in the EHR, and escalating ADRrelated dose modifications to the proper institutional channels for reporting. CONCLUSION: There is a need to expand the current ADR reporting methods aided by EHRfacilitated quality improvement activities of the clinical pharmacy services to advance pharmacovigilance. The need to identify opportunities for the improvement of quality patient care created a framework for the development of a proactive, technology-aided method to advance pharmacovigilance for patients at SMH's infusion center. Further analysis of the confirmed ADRs to identify educational and prevention measures would improve the care of patients, as well as advance the role of clinical pharmacists. [ABSTRACT FROM AUTHOR]