Development and validation of a clinical decision support system to prevent anticoagulant duplications.

Autor: Dahmke H; Hospital Pharmacy, Kantonsspital Aarau, 5000 Aarau, Switzerland. Electronic address: hendrike.dahmke@ksa.ch., Cabrera-Diaz F; Hospital Pharmacy, General University Hospital of Ciudad Real, 13005 Ciudad Real, Spain., Heizmann M; Division of Oncology, Haematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland., Stoop S; Department of Chemistry and Applied Biosciences, Eidgenossische Technische Hochschule Zürich, Zurich, Switzerland., Schuetz P; Department of Internal Medicine, Kantonsspital Aarau, 5000 Aarau, Switzerland., Fiumefreddo R; Department of Internal Medicine, Kantonsspital Aarau, 5000 Aarau, Switzerland., Zaugg C; Hospital Pharmacy, Kantonsspital Aarau, 5000 Aarau, Switzerland.
Jazyk: angličtina
Zdroj: International journal of medical informatics [Int J Med Inform] 2024 Jul; Vol. 187, pp. 105446. Date of Electronic Publication: 2024 Apr 07.
DOI: 10.1016/j.ijmedinf.2024.105446
Abstrakt: Background and Objective: Unintended duplicate prescriptions of anticoagulants increase the risk of serious adverse events. Clinical Decision Support Systems (CDSSs) can help prevent such medication errors; however, sophisticated algorithms are needed to avoid alert fatigue. This article describes the steps taken in our hospital to develop a CDSS to prevent anticoagulant duplication (AD).
Methods: The project was composed of three phases. In phase I, the status quo was established. In phase II, a clinical pharmacist developed an algorithm to detect ADs using daily data exports. In phase III, the algorithm was integrated into the hospital's electronic health record system. Alerts were reviewed by clinical pharmacists before being sent to the prescribing physician. We conducted a retrospective analysis of all three phases to assess the impact of the interventions on the occurrence and duration of ADs. Phase III was analyzed in more detail regarding the acceptance rate, sensitivity, and specificity of the alerts.
Results: We identified 91 ADs in 1581 patients receiving two or more anticoagulants during phase I, 70 ADs in 1692 patients in phase II, and 57 ADs in 1575 patients in phase III. Mean durations of ADs were 1.8, 1.4, and 1.1 calendar days during phases I, II, and III, respectively. In comparison to the baseline in phase I, the relative risk reduction of AD in patients treated with at least two different anticoagulants during phase III was 42% (RR: 0.58, CI: 0.42-0.81). A total of 429 alerts were generated during phase III, many of which were self-limiting, and 186 alerts were sent to the respective prescribing physician. The acceptance rate was high at 97%. We calculated a sensitivity of 87.4% and a specificity of 87.9%.
Conclusion: The stepwise development of a CDSS for the detection of AD markedly reduced the frequency and duration of medication errors in our hospital, thereby improving patient safety.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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