• Int J Med Inform · Oct 2013

    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.

    • A Boussadi, T Caruba, A Karras, S Berdot, P Degoulet, P Durieux, and B Sabatier.
    • Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Département d'Informatique Hospitalière - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; UPMC University (Paris 06), Paris, France. Electronic address: abdelali.boussadi@egp.aphp.fr.
    • Int J Med Inform. 2013 Oct 1;82(10):964-72.

    ObjectiveThe 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 MethodsThe 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.ResultsThe 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.ConclusionThis study strongly suggests that an alert system would be complementary to the pharmacists' activity and contribute to drug prescription safety.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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