Evaluation of medication safety in the discharge medication of 509 surgical inpatients using electronic prescription support software and an extended operational interaction classification Frölich, T B Abstract: Purpose We aimed to study drug interactions and dose adjustments for renal impairment in the discharge medication of surgical inpatients, and to evaluate strengths and limitations of Clinical Decision Support software (CDSS) for this task. Methods Cross-sectional study in 509 surgical patients of a primary care hospital. We developed a customized interface for the CDSS MediQ, which we used for automated retrospective identification of drug interactions in the patients' discharge medication. Clinical relevance of interactions was evaluated based on the Zurich Interaction System (ZHIAS) that incorporates the Operational Classification of Drug Interactions (ORCA). Prescriptions were further analyzed for recommended dose adjustments in patients with a GFR <60 ml/min. Results In 509 patients with 2,729 prescriptions MediQ generated 2,558 interaction alerts and 1,849 comments. Among those there were 10 "high danger" and 551 "average danger" alerts that we reclassified according to ORCA criteria. This resulted in 10 contraindicated combinations, 77 provisionally contraindicated combinations, 310 with a conditional and 164 with a minimal risk of adverse outcomes. The ZHIAS classification also provides categorical information on expected adverse outcomes and management recommendations, which are presented in detail. We identified 56 prescriptions without recommended dose adjustment for impaired renal function. Conclusions CDSS identified a large number of drug interactions in surgical discharge medication, but according to ZHIAS criteria only a minor fraction appears to involve a substantial risk. CDSS should aim at reducing over-alerting and improve usability in order to become more efficacious regarding the prevention of adverse drug events in clinical practice.
The proximal humeral fracture occurs very often especially in elderly patients suffering from osteoporosis. Minimally invasive internal fixation with the Targon®-PH proximal humeral nail may lead to quick recovery. Thirty-nine patients with unstable humeral head fractures with two or four fragments were included into this study. The application of the humeral nail was achieved by deltoid split technique. Patients were followed-up clinically and radiologically including a Constant Score. The mean age was 72.9±3.3years of the male and 74.9±1.8years of the female patients. The subjective parameters of the Constant-Murley Score were significantly lowered in both the female and the male sample compared with the healthy side (female 30.0±1.1 vs. 33.7±0.7; P<0.05; and male 30.3±1.4 vs. 34.0±0.7; P<0.05). The objective parameters were significantly lowered also in both the female and the male sample compared with the non-operated side (female 34.5±2.0 vs. 45.2±1.1; P<0.001; and male 37.7±5.4 vs. 50.6±1.7; P<0.05). Even under lowered functionality, the subjective satisfaction was high; therefore, nailing of proximal humeral head fractures may represent a method for early functional recovery in elderly patients
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