Abstract
BackgroundClinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm. They are however associated with a high burden of false positive alerts and alert fatigue. The aim of this study was to evaluate a drug–drug interaction (DDI) clinical decision support system in terms of its performance, uptake and user satisfaction and to identify barriers and opportunities for improvement.MethodsA quantitative evaluation and end-user survey were performed in a large teaching hospital. First, very severe DDI alerts generated between 2019 and 2021 were evaluated retrospectively. Data collection comprised alert burden, override rates, the number of alert overrides reviewed by pharmacists and the resulting pharmacist recommendations as well as their acceptance rate. Second, an e-survey was carried out among prescribers to assess satisfaction, usefulness and relevance of DDI alerts as well as reasons for overriding.ResultsA total of 38,409 very severe DDI alerts were generated, of which 88.2% were overridden by the prescriber. In 3.2% of reviewed overrides, a recommendation by the pharmacist was provided, of which 79.2% was accepted. False positive alerts were caused by a too broad screening interval and lack of incorporation of patient-specific characteristics, such as QTc values. Co-prescribing of a non-vitamin K oral anticoagulant and a low molecular weight heparin accounted for 49.8% of alerts, of which 92.2% were overridden. In 88 (1.1%) of these overridden alerts, concurrent therapy was still present. Despite the high override rate, the e-survey revealed that the DDI clinical decision support system was found useful by prescribers.ConclusionsIdentified barriers were the lack of DDI-specific screening intervals and inclusion of patient-specific characteristics, both leading to a high number of false positive alerts and risk for alert fatigue. Despite these barriers, the added value of the DDI clinical decision support system was recognized by prescribers. Hence, integration of DDI-specific screening intervals and patient-specific characteristics is warranted to improve the performance of the DDI software.
Highlights
Clinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm
Quantitative evaluation During the 2-year study period, 110,400 patients were hospitalized in UZ University Hospitals Leuven (Leuven), 232,948 patients were admitted to the day care hospital and 4,241,087 prescriptions were created
Our study showed that the current Clinical decision support system (CDSS) for very severe drug–drug interaction (DDI) had a limited initial acceptance rate of 11.8%
Summary
Clinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm. They are associated with a high burden of false positive alerts and alert fatigue. Medication errors are an important threat to patient safety. They can result in adverse drug events, which occur in 6 to 19% of hospitalized patients and which might negatively impact the patient’s health status as. Up to one-half of adverse drug events are due to medication errors and are preventable [1, 4, 5]. 5–17% of adverse drug events among inpatients are caused by drug–drug interactions (DDIs) [1, 6]. Medication errors remain relatively common, during prescribing, accounting for 7% of all prescriptions in inpatients [8]
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