Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing

Abstract

Background Drug related problems (DRPs) are frequent and cause suffering for patients and substantial costs for society. Multi-dose drug dispensing (MDDD) is a service by which patients receive their medication packed in bags with one unit for each dose occasion. The clinical decision support system (CDSS) electronic expert support (EES) analyses patients' prescriptions in the Swedish national e-prescription repository and provides alerts if potential DRPs are detected, i.e. drug-drug interactions, duplicate therapy, drug-disease contraindications, high dose, gender warnings, geriatric, and paediatric alerts. Objective To analyse potential DRPs in patients with MDDD, detected by means of EES. Setting A register study of all electronically stored prescriptions for patients with MDDD in Sweden (n = 180,059) March 5-June 5, 2013. Method Drug use and potential DRPs detected in the study population during the 3 month study period by EES were analysed. The potential DRPs were analysed in relation to patients' age, gender, number of drugs, and type of medication. Main outcome measure Prevalence of potential DRPs measured as EES alerts. Results The study population was on average 75.8 years of age (± 17.5, range 1-110) and had 10.0 different medications (± 4.7, range 1-53). EES alerted for potential DRPs in 76 % of the population with a mean of 2.2 alerts per patient (± 2.4, range 0-27). The older patients received a lower number of alerts compared to younger patients despite having a higher number of drugs. The most frequent alert categories were drug-drug interactions (37 % of all alerts), duplicate therapy (30 %), and geriatric warnings for high dose or inappropriate drugs (23 %). Psycholeptics, psychoanaleptics, antithrombotic agents, anti-epileptics, renin-angiotensin system agents, and analgesics represented 71 % of all drugs involved in alerts. Conclusions EES detected potential DRPs in the majority of patients with MDDD. The number of potential DRPs was associated with the number of drugs, age, gender, and type of medication. A CDSS such as EES might be a useful tool for physicians and pharmacists to assist in the important task of monitoring patients with MDDD for potential DRPs.

The Use of a Decision Support System in Swedish Pharmacies to Identify Potential Drug-Related Problems—Effects of a National Intervention Focused on Reviewing Elderly Patients’ Prescriptions

“…EES is a government-owned CDSS that analyses patients´ electronically stored prescriptions in the Swedish national prescription repository. It was originally developed by Medco Health Solutions in the US and has been adapted to Swedish clinical practice [ 25 ]. EES is available to Swedish pharmacies and is developed and maintained by the Swedish eHealth Agency.…”

“…EES is not available to prescribers in Swedish health care. Previous studies have described the potential DRPs detected by EES in patients with multi-dose drug dispensing and have shown that physicians regard the majority of alerts as clinically relevant [ 25 , 26 ]. Although EES has been available at pharmacies for many years, its use has been low and only studied in a few small studies where most of them are not published scientifically [ 27 ].…”

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

“…17 Several systems have been proposed for the classification of DRP, with the Pharmaceutical Care Network Europe (PCNE) being one of the most commonly used classification systems in hospital practice. 18 Several DRP detection strategies have been developed, including pharmacist review of medication orders (MO), the use of computerised physician order entry (CPOE) systems couple with clinical decision support programs [19][20][21] that allow the clinical pharmacist to have an active participation within the healthcare team. 5 8 22-24 However, despite the clinical and economic relevance of DRP, very few studies have investigated the incidence, types and causes of DRP in patients hospitalised in general medical and surgical wards.…”

Evaluation of the Pharmacy Support System in the Detection of Drug-Related Problems

“…Improper doses primarily identified in geriatric and pediatric patients' prescription. The study by Tora et al (2014) shows that the warning category for potential DRPs frequently identified by EES/CDSS in the age group >65 years old is drug-drug interaction with drug (38.6%), geriatric warning (30.8%), and duplications of therapy (25.6%). The geriatric warning includes warning in drug inaccuracies in the elderly (11% warning), extremely high doses (9%), and more than 3 types of psychotropic drug (3%) (Table 4) [4].…”

“…Thereby, that the information technology in treatment management process has been suggested to improve appropriate and safe treatment. The utilization of computerized-based information technology is proven to efficiently assist the pharmacists in identifying potential DRPs [3][4][5][6].…”