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

Abstract

This study strongly suggests that an alert system would be complementary to the pharmacists' activity and contribute to drug prescription safety.

Renal Drug Dosing

“…There is another potential issue with prescriber-based CDSS. It has been reported that EHR alerts displayed during CPOE are commonly ignored [9,[25][26][27]. While prescribers may be more likely to act on the severity of the alert [25], it is unknown how prescribers view the severity of renal dose adjustment alerts.…”

“…Clinical decision support systems (CDSS) have been developed within electronic health records (EHR) to identify patients with renal impairment when such patients are prescribed a medication that requires renal adjustment/contraindication [4,[8][9][10]. These systems require patient-specific laboratory and demographic data to be available during medication ordering or dispensing.…”

“…Some systems provide notification and clinical decision support to the prescriber while others target the dispensing pharmacist. While CDSS generally have demonstrated improvements in appropriate drug dosing, most reports are from the inpatient setting [8][9][10][11]. Conversely, reports from the outpatient setting are few and restricted to specific medications or populations (e.g., erythropoietin and patients requiring dialysis) [8,12].…”

Complex Drug–Drug–Gene–Disease Interactions Involving Cytochromes P450: Systematic Review of Published Case Reports and Clinical Perspectives

“…Computerized physician order entry (CPOE) systems currently include DDI checking tools, most of which are integrating alert systems [209]. In some advanced systems, renal and hepatic functions can also be incorporated, and dose adaptation might be recommended according to the estimated GFR and/or liver functional status [210]. A recent meta-analysis highlighted the discrepancy between the high prevalence of potential DDIs and the low prevalence of actual DDIs leading to clinical harm [211].…”

How mobile devices are changing pharmacy practice

“…Boussadi and colleagues 43 investigated alert systems embedded within electronic health records (EHRs), such as those that addressed renal function and anticoagulation concerns, to complement pharmacist activities and improve safety benefits. Of the 5006 drug prescription lines analyzed, the alert system correctly analyzed 4863 (97.14%), whereas the pharmacists correctly analyzed 4745 (94.77%) of the same lines.…”