Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists' analysis of medication orders in hospitals

被引：22

作者：

Boussadi, A. ^{[1
,2
,3
,7
]}

Caruba, T. ^{[4
,6
]}

Karras, A. ^{[5
]}

Berdot, S. ^{[1
,2
,4
,7
]}

Degoulet, P. ^{[1
,2
,3
]}

Durieux, P. ^{[1
,2
,3
]}

Sabatier, B. ^{[1
,2
,4
]}

机构：

[1] Univ Paris 05, Paris, France

[2] INSERM, UMR S Eq 872 22, Paris, France

[3] Hop Europeen Georges Pompidou, DIH, F-75908 Paris 15, France

[4] Hop Europeen Georges Pompidou, Serv Pharm, F-75908 Paris 15, France

[5] Hop Europeen Georges Pompidou, Serv Nephrol, F-75908 Paris 15, France

[6] LIRAES EA 4470, Paris, France

[7] Univ Paris 09, UPMC, Paris, France

来源：

INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS | 2013年 / 82卷 / 10期

关键词：

Computer-assisted; Decision support techniques; Software validation; Medication errors/prevention & control; Pharmaceutical preparations/administration & dosage; Drug dosage calculations; Drug prescriptions; PHARMACEUTICAL VALIDATION; SUPPORT-SYSTEMS; BUSINESS RULES; EVENTS; ENTRY; CARE; PERFORMANCE; MANAGEMENT; FRAMEWORK; CHECKLIST;

D O I：

10.1016/j.ijmedinf.2013.06.006

中图分类号：

TP [自动化技术、计算机技术];

学科分类号：

0812 ;

摘要：

Objective: The main objective of this study was to assess the diagnostic performances of an alert system integrated into the CPOE/EMR system for renally cleared drug dosing control. The generated alerts were compared with the daily routine practice of pharmacists as part of the analysis of medication orders. Materials and methods: The pharmacists performed their analysis of medication orders as usual and were not aware of the alert system interventions that were not displayed for the purpose of the study neither to the physician nor to the pharmacist but kept with associate recommendations in a log file. A senior pharmacist analyzed the results of medication order analysis with and without the alert system. The unit of analysis was the drug prescription line. The primary study endpoints were the detection of drug dose prescription errors and inter-rater reliability (Kappa coefficient) between the alert system and the pharmacists in the detection of drug dose error. Results: The alert system fired alerts in 8.41% (421/5006) of cases: 5.65% (283/5006) "exceeds max daily dose" alerts and 2.76% (138/5006) "under-dose" alerts. The alert system and the pharmacists showed a relatively poor concordance: 0.106 (CI 95% [0.068-0.144]). According to the senior pharmacist review, the alert system fired more appropriate alerts than pharmacists, and made fewer errors than pharmacists in analyzing drug dose prescriptions: 143 for the alert system and 261 for the pharmacists. Unlike the alert system, most diagnostic errors made by the pharmacists were 'false negatives'. The pharmacists were not able to analyze a significant number (2097; 25.42%) of drug prescription lines because understaffing. Conclusion: This study strongly suggests that an alert system would be complementary to the pharmacists' activity and contribute to drug prescription safety. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

引用

页码：964 / 972

页数：9

共 29 条

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