Abstract
BackgroundTo improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called “Check of Medication Appropriateness” (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. The aim of this study is twofold: 1) describing the development of CMA and 2) evaluating the preliminary results, more specifically the number of clinical rule alerts, number of actions on the alerts and acceptance rate by physicians.MethodsCMA focuses on patients at risk for potentially inappropriate medication and involves the daily checking by a pharmacist of high-risk prescriptions generated by advanced clinical rules integrating patient specific characteristics with details on medication. Pharmacists’ actions are performed by adding an electronic note in the patients’ medical record or by contacting the physician by phone. A retrospective observational study was performed to evaluate the primary outcomes during an 18-month study period.Results39,481 clinical rule alerts were checked by pharmacists for which 2568 (7%) electronic notes were sent and 637 (1.6%) phone calls were performed. 37,782 (96%) alerts were checked within four pharmacotherapeutic categories: drug use in renal insufficiency (25%), QTc interval prolonging drugs (11%), drugs with a restricted indication or dosing (14%) and overruled very severe drug-drug interactions (50%). The emergency department was a frequently involved ward and anticoagulants are the drug class for which actions are most frequently carried out. From the 458 actions performed for the four abovementioned categories, 69% were accepted by physicians.ConclusionsThese results demonstrate the added value of CMA to support medication surveillance in synergy with already integrated basic clinical decision support and bedside clinical pharmacy. Otherwise, the study also highlighted a number of limitations, allowing improvement of the service.
Highlights
To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called “Check of Medication Appropriateness” (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness
Due to limited healthcare budget, which is the case in many European countries, bedside clinical pharmacy services are not implemented on a hospital-wide basis but restricted to high-risk patient populations such as geriatric patients characterized by polypharmacy, critically ill patients or patients admitted at the emergency department or on surgical wards with rapid patient turnover [5, 6]
Quantitative evaluation of preliminary results During the 18-month study period, 92,050 clinical rule alerts were extracted for which 24,943 (27%) electronic notes were sent and 637 (0.7%) electronic notes supplemented by phone calls were carried out
Summary
To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called “Check of Medication Appropriateness” (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. Inappropriate prescribing has been shown to be an independent risk factor for adverse drug events (ADE) and several studies reported that ADEs can cause hospitalization [1]. Half of these hospital admissions are preventable [2, 3]. In order to augment the safety and quality of patients’ therapy, front-office bedside clinical pharmacy services were set up in many European countries, after these were implemented in the UK, Canada and the USA since the ‘70s [5].
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