Int J Med Inform - 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.

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Resumo

JECTIVE: The main objective of this study was to assess the diagnostic performances of an alert system integrated into the CPOE/EMR system for renally cleared drug dosing control. The generated alerts were compared with the daily routine practice of pharmacists as part of the analysis of medication orders.MATERIALS AND METHODS: The pharmacists performed their analysis of medication orders as usual and were not aware of the alert system interventions that were not displayed for the purpose of the study neither to the physician nor to the pharmacist but kept with associate recommendations in a log file. A senior pharmacist analyzed the results of medication order analysis with and without the alert system. The unit of analysis was the drug prescription line. The primary study endpoints were the detection of drug dose prescription errors and inter-rater reliability (Kappa coefficient) between the alert system and the pharmacists in the detection of drug dose error.RESULTS: The alert system fired alerts in 8.41% (421/5006) of cases: 5.65% (283/5006) "exceeds max daily dose" alerts and 2.76% (138/5006) "under-dose" alerts. The alert system and the pharmacists showed a relatively poor concordance: 0.106 (CI 95% [0.068-0.144]). According to the senior pharmacist review, the alert system fired more appropriate alerts than pharmacists, and made fewer errors than pharmacists in analyzing drug dose prescriptions: 143 for the alert system and 261 for the pharmacists. Unlike the alert system, most diagnostic errors made by the pharmacists were 'false negatives'. The pharmacists were not able to analyze a significant number (2097; 25.42%) of drug prescription lines because understaffing.CONCLUSION: This study strongly suggests that an alert system would be complementary to the pharmacists' activity and contribute to drug prescription safety.

Resumo Limpo

jectiv main object studi assess diagnost perform alert system integr cpoeemr system renal clear drug dose control generat alert compar daili routin practic pharmacist part analysi medic ordersmateri method pharmacist perform analysi medic order usual awar alert system intervent display purpos studi neither physician pharmacist kept associ recommend log file senior pharmacist analyz result medic order analysi without alert system unit analysi drug prescript line primari studi endpoint detect drug dose prescript error interrat reliabl kappa coeffici alert system pharmacist detect drug dose errorresult alert system fire alert case exceed max daili dose alert underdos alert alert system pharmacist show relat poor concord ci accord senior pharmacist review alert system fire appropri alert pharmacist made fewer error pharmacist analyz drug dose prescript alert system pharmacist unlik alert system diagnost error made pharmacist fals negat pharmacist abl analyz signific number drug prescript line understaffingconclus studi strong suggest alert system complementari pharmacist activ contribut drug prescript safeti

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