Development and Evaluation of a Clinical Decision Support System to Improve Medication Safety
Development and Evaluation of a Clinical Decision Support System to Improve Medication Safety
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DOI：
10.1055/s-0039-1693426
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发表时间：
2019-05-01
影响因子：
2.9
通讯作者：
Sanjurjo Saez, Maria
中科院分区：
文献类型：
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作者：
Ibanez-Garcia, Sara;Rodriguez-Gonzalez, Carmen;Sanjurjo Saez, Maria
背景临床决策支持系统(CDSS)是预防用药差错、降低不良药物事件(ADE)发生率和严重程度的良好策略。目的本研究的目的是评价一种先进的CDSS HIGEA的有效性，该系统根据预先定义的临床规则生成警报，以识别有ADE风险的患者。方法多学科团队针对临床实践中常见的用药差错定义了该系统和临床规则。确定了四个干预方案：(1)肾损害的剂量调整；(2)抗凝/抗血小板治疗的调整；(3)生化/血液毒性的检测；(4)治疗药物监测。我们进行了为期6个月的观察性前瞻性研究，通过计算阳性预测值(PPV)来分析这些临床规则的有效性。在研究期间，HIGEA产生了1086个警报(每个工作日8.9个警报)，药剂师对这些警报进行了审查。51%(554/1,086)的警报产生了干预措施，以防止可能的ADE；其中66%(368/554)由于截获的真实处方错误而需要对治疗进行书面修改。修改治疗次数最多的干预方案是肾损害剂量调整方案(PPV=0.51)，其次是抗凝/抗血小板治疗方案调整(PPV=0.24)。接受干预的比例在外科病房(68%)、内科病房(67%)和重症监护病房(63%)相似。结论我们的研究提供了证据，HIGEA在处方阶段预防潜在的ADE是非常有效的。
Background Clinical decision support systems (CDSSs) are a good strategy for preventing medication errors and reducing the incidence and severity of adverse drug events (ADEs). However, these systems are not very effective and are subject to multiple limitations that prevent their implementation in clinical practice.Objectives The objective of this study was to evaluate the effectiveness of an advanced CDSS, HIGEA, which generates alerts based on predefined clinical rules to identify patients at risk of an ADE.Methods A multidisciplinary team defined the system and the clinical rules focusing on medication errors commonly encountered in clinical practice. Four intervention programs were defined: (1) dose adjustment in renal impairment; (2) adjustment of anticoagulation/antiplatelet therapy; (3) detection of biochemical/hematologic toxicities; and (4) therapeutic drug monitoring. We performed a 6-month observational prospective study to analyze the effectiveness of these clinical rules by calculating the positive predictive value (PPV).Results The team defined 211 clinical rules. During the study period, HIGEA generated 1,086 alerts (8.9 alerts per working day), which were reviewed by pharmacists. Fifty-one percent (554/1,086) of alerts generated an intervention to prevent a possible ADE; of these, 66% (368/554) required a documented modification to therapy owing to a real prescription error intercepted. The intervention program that induced the highest number of modifications to therapy was the dose adjustment in renal impairment program (PPV = 0.51), followed by the adjustment of anticoagulation/antiplatelet therapy program (PPV = 0.24). The percentage of accepted interventions was similar in surgical units (68%), medical units (67%), and critical care units (63%).Conclusion Our study offers evidence that HIGEA is highly effective in preventing potential ADEs at the prescription stage.