Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study

Carlota Mestres Gonzalvo,Paul-Hugo M Van Der Kuy,Frans R Verhey,Kim P G M Hurkens,Brigit P C Van Oijen,Hugo A J M De Wit,Rob Janknegt,Wubbo J Mulder,Bjorn Winkens,Jos M G A Schols

doi:10.1186/s12877-017-0426-3

Carlota Mestres Gonzalvo, Paul-Hugo M Van Der Kuy + Show 8 more

Open Access

https://doi.org/10.1186/s12877-017-0426-3

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Abstract

BackgroundIn the nursing home population, it is estimated that 1 in every 3 patients is polymedicated and given their considerable frailty, these patients are especially prone to adverse drug reactions. Clinical pharmacist-led medication reviews are considered successful interventions to improve medication safety in the inpatient setting. Due to the limited available evidence concerning the benefits of medication reviews performed in the nursing home setting, we propose a study aiming to demonstrate a positive effect that a clinical decision support system, as a health care intervention, may have on the target population. The primary objective of this study is to reduce the number of patients with at least one event when using the clinical decision support system compared to the regular care. These events consist of hospital referrals, delirium, falls, and/or deaths.Method/DesignThis study is a multicentre, prospective, randomised study with a cluster group design. The randomisation will be per main nursing home physician and stratified per ward (somatic and psychogeriatric). In the intervention group the clinical decision support system will be used to screen medication list, laboratory values and medical history in order to obtain potential clinical relevant remarks. The remarks will be sent to the main physician and feedback will be provided whether the advice was followed or not. In the control group regular care will be applied.DiscussionWe strongly believe that by using a clinical decision support system, medication reviews are performed in a standardised way which leads to comparable results between patients. In addition, using a clinical decision support system eliminates the time factor to perform medication reviews as the major problems related to medication, laboratory values, indications and/or established patient characteristics will be directly available. In this way, and in order to make the medication review process complete, consultation within healthcare professionals and/or the patient itself will be time effective and the medication surveillance could be performed around the clock.Trial registrationThe Netherlands National Trial Register NTR5165. Registered 2nd April 2015.

Highlights

In the nursing home population, it is estimated that 1 in every 3 patients is polymedicated and given their considerable frailty, these patients are especially prone to adverse drug reactions
We strongly believe that by using a clinical decision support system, medication reviews are performed in a standardised way which leads to comparable results between patients
Using a clinical decision support system eliminates the time factor to perform medication reviews as the major problems related to medication, laboratory values, indications and/or established patient characteristics will be directly available

Summary

Introduction

In the nursing home population, it is estimated that 1 in every 3 patients is polymedicated and given their considerable frailty, these patients are especially prone to adverse drug reactions. In the nursing home population, it is estimated that 1 in every 3 patients is polymedicated [4] and given their considerable frailty, these patients are extra prone to adverse drug reactions. Their management is often challenging given the comorbidities and/or complex organ function impairment [1, 2, 5,6,7,8]. This situation strengthens the need for routine medication reviews and treatment optimisation [10, 11]

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