Abstract
BackgroundUpon admission to a hospital patients’ medications are frequently switched to alternative drugs compiled in so called hospital drug formularies. This substitution process is a laborious and error-prone task which should be supported by sophisticated electronic tools. We developed a computerised decision support system and evaluated benefit and potential harm associated with its use.MethodsBased on a multi-step algorithm we identified drug classes suitable for exchange, defined conversion factors for therapeutic interchange, built a web-based decision support system, and implemented it into the computerised physician order entry of a large university hospital. For evaluation we compared medications manually switched by clinical pharmacists with the results of automated switching by the newly developed computer system and optimised the system in an iterative process. Thereafter the final system was tested in an independent set of prescriptions.ResultsAfter iterative optimisation of the logical framework the tool was able to switch drugs to pharmaceutical equivalents and alternatives; in addition, it contained 21 different drug classes for therapeutic substitution. In this final version it switched 91.6% of 202 documented medication consultations (containing 1,333 drugs) automatically, leaving 8.4% for manual processing by clinical professionals. No incorrect drug switches were found.ConclusionA large majority (>90%) of drug switches performed at the interface between primary and tertiary care can be handled automatically using electronic decision support systems, indicating that medication errors and workload of healthcare professionals can be considerably reduced.
Highlights
Upon admission to a hospital patients’ medications are frequently switched to alternative drugs compiled in so called hospital drug formularies
In a pilot investigation assessing the quality of drug switching we evaluated 128 switches in 30 consecutively admitted patients and learnt that one in five drug substitutions (21%) was wrong, mainly due to dose errors or mistakes in switching combination drugs to multiple single agents
Pilot evaluation of the clinical decision support systems (CDSS) In the first evaluation 174 documented drug switch consultations were included containing 1,296 drugs manually switched by the team of clinical pharmacists. 1,176 of these (90.7%) could be entered into the evaluationdatabase; the remaining 120 (9.3%) were excluded because essential information was missing on the handwritten consultations
Summary
Upon admission to a hospital patients’ medications are frequently switched to alternative drugs compiled in so called hospital drug formularies. This substitution process is a laborious and error-prone task which should be supported by sophisticated electronic tools. We developed a computerised decision support system and evaluated benefit and potential harm associated with its use. The number and severity of these errors, which compromised optimum treatment already on the first day of hospitalisation, was alarming and we, decided to support the process of drug switching electronically. Computerised physician order entry (CPOE) and clinical decision support systems (CDSS) have successfully prevented prescription errors, improved patient outcome, and reduced cost [5,6,7,8,9]
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