| Popis: |
Inadequate therapy often leads to adverse drug events (ADEs) which can be prevented by information technology support. The aim of this study was to analyse the results and the performance of the automated interaction check system that is implemented in the computerized physician order entry system inorder to identify current problems and shortcomings. This was investigated in a prospective (geriatric ward) and retrospective manner (hospital wide). A total of 45 ADEs were identified in 31 patients during a prospective study (6.7% of ADEs certainly, 51.1% of ADEs likely, 22.2% of ADEs possibly, and 20.0% of ADEs unlikely attributable to drug-drug interactions). Symptoms that most often occurred were falls (20.4%) and hypotension (18.5%). In the retrospective study, 2890 alerts were generated by the drug-drug interaction module and 82.1% of them were overridden. The most common alert (72.1%) was a warning for the risk of hyperkalemia. The study showed that ADEs occur frequently in the elderly and can be reduced by clinical pharmacists' interventions. An automated alert system can improve patient safety but can also cause alert fatigue if the rate of overridden alerts is too high. On the basis of retrospective and prospective studies the system was fine-tuned in such a way that alerts are appearing only when clinically relevant. Neustrezno zdravljenje pogosto privede do neželenih dogodkov zdravljenja z zdravili (NDZ), vendar je danes na voljo podpora informacijskih sistemov, s pomočjo katere lahko NDZ v veliki meri preprečimo. Namen študije je bil analizirati rezultate in zmogljivost avtomatskega sistema za spremljanje interakcij med zdravili v bolnišnici Universitair Ziekenhuis Brussel ter identificirati obstoječe težave in pomanjkljivosti. To smo raziskali s prospektivno (geriatrični oddelek) in retrospektivno študijo (celotna bolnišnica). Med prospektivno študijo smo pri 31 bolnikih identificirali 45 NDZ povezanih z interakcijami (3 NDZ so bili ocenjeni kot nedvomno, 23 kot verjetno, 10 kot možno in 9 kot malo verjetno povezani z interakcijami med zdravili). Simptomi NDZ, ki so se najpogosteje pojavljali, so bili padci (20,4%) in hipotenzija (18,5%). Med retrospektivno študijo je bilo s pomočjo modula za odkrivanje interakcij med zdravili generiranih 2890 opozoril in 82,1% le-teh zdravniki pri predpisovanju zdravil niso upoštevali. Najbolj pogosto opozorilo (72,1 %) je bilo opozorilo za nevarnost hiperkaliemije. Študija je pokazala, da so NDZ pri starejših pogosti in da je možno njihov pojav zmanjšati s farmacevtskimi intervencijami. Avtomatski sistem za spremljanje interakcij med zdravili je dobro orodje za izboljšanje bolnikove varnosti, vendar lahko povzroči tudi napake, če je stopnja neupoštevanih opozoril previsoka. Na podlagi rezultatov retrospektivne in prospektivne študije je bil sistem prilagojen do te mere, da se opozorila generirajole v trenutku, ko so klinično relevantna. |
