Improving medication-related clinical decision support
Improving medication-related clinical decision support
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DOI：
10.2146/ajhp160830
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发表时间：
2018-02-15
影响因子：
2.7
通讯作者：
Bates, David W.
中科院分区：
文献类型：
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作者：
Tolley, Clare L.;Slight, Sarah P.;Bates, David W.
目的。回顾了药物相关临床决策支持 (CDS) 的当前使用以及改进这些系统的建议。总结。采用系统方法，使用与 5 种基本药物相关 CDS 功能相关的 MeSH 术语和关键字在 MEDLINE 和 EMBASE 中识别 2007 年至 2014 年发表的文章。共审查了 5 个领域的 156 篇全文文章和 28 篇会议摘要：药物相互作用 (DDI) 检查 (n = 78)、药物过敏检查 (n = 20)、药物剂量支持 (n = 55)、药物重复检查 (n = 11) 和药物处方支持 (n = 20)。与药物相关的 CDS 的成功取决于用户发现警报有价值并根据收到的信息采取行动。提高警报的特异性和敏感性对于所有领域都很重要。分层对于提高 DDI 警报的接受度非常重要。进行适当的交叉敏感性检查的能力是进行适当的药物过敏检查的关键。药物剂量警报应个性化并提供实用的建议。如何配置系统来识别某些药物重复对于防止可能的患者毒性非常重要。需要准确的知识数据库来生成相关的药物处方警报并鼓励遵守处方。在一些组织中，与药物相关的 CDS 仍然相对不成熟，还有很大的改进空间。例如，决策支持应考虑更多患者特定因素，应始终考虑人为因素原则，必须提高警报特异性以减少警报疲劳。结论。标准化、患者特定参数的整合以及人为因素设计原则的考虑对于实现药物相关 CDS 的潜在益处至关重要。
Purpose. Current uses of medication-related clinical decision support (CDS) and recommendations for improving these systems are reviewed.Summary. Using a systematic approach, articles published from 2007 through 2014 were identified in MEDLINE and EMBASE using MeSH terms and keywords relating to the 5 basic medication-related CDS functionalities. A total of 156 full-text articles and 28 conference abstracts were reviewed across each of the 5 areas: drug-drug interaction (DDI) checks (n = 78), drug allergy checks (n = 20), drug dose support (n = 55), drug duplication checks (n = 11), and drug formulary support (n = 20). The success of medication-related CDS depends on users finding the alerts valuable and acting on the information received. Improving alert specificity and sensitivity is important for all domains. Tiering is important for improving the acceptance of DDI alerts. The ability to perform appropriate crosssensitivity checks is key to producing appropriate drug allergy checks. Drug dosage alerts should be individualized and deliver practical recommendations. How the system is configured to identify certain drug duplications is important to prevent possible patient toxicity. Accurate knowledge databases are needed to produce relevant drug formulary alerts and encourage formulary adherence. Medication-related CDS is still relatively immature in some organizations and has substantial room for improvement. For example, decision support should consider more patient-specific factors, human factors principles should always be considered, and alert specificity must be improved in order to reduce alert fatigue.Conclusion. Standardization, integration of patient-specific parameters, and consideration of human factors design principles are central to realizing the potential benefits of medication-related CDS.