The support of medication reviews in hospitalised patients using a clinical decision support system.

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

doi:10.1186/s40064-016-2376-1

Abstract

ObjectivesFirst, to estimate the added value of a clinical decision support system (CDSS) in the performance of medication reviews in hospitalised elderly. Second, to identify the limitations of the current CDSS by analysing generated drug-related problems (DRPs).MethodsMedication reviews were performed in patients admitted to the geriatric ward of the Zuyderland medical centre. Additionally, electronically available patient information was introduced into a CDSS. The DRP notifications generated by the CDSS were compared with those found in the medication review. The DRP notifications were analysed to learn how to improve the CDSS.ResultsA total of 223 DRP strategies were identified during the medication reviews. The CDSS generated 70 clinically relevant DRP notifications. Of these DRP notifications, 63 % (44) were also found during the medication reviews. The CDSS generated 10 % (26) new DRP notifications and conveyed 28 % (70) of all 249 clinically relevant DRPs that were found. Classification of the CDSS generated DRP notifications related to ‘medication error type’ revealed that ‘contraindications/interactions/side effects’ and ‘indication without medication’ were the main categories not identified during the manual medication review. The error types ‘medication without indication’, ‘double medication’, and ‘wrong medication’ were mostly not identified by the CDSS.ConclusionsThe CDSS used in this study is not yet sufficiently advanced to replace the manual medication review, though it does add value to the manual medication review. The strengths and weaknesses of the current CDSS can be determined according to the medication error types.

Highlights

Frailty in the aging patient is a state of vulnerability in which health status can suddenly decrease as a result of relatively small health events (Clegg et al 2013)
Drug‐related problems The pharmacist who prepared the gerontopharmacology meeting had a total of 221 drug-related problems (DRPs) suggestions based on the 33 medication reviews
Of these 221 DRP suggestions, 166 DRP suggestions were accepted as DRP strategies, while 55 DRP suggestions were rejected and an additional 57 DRP remarks were introduced during the meeting and accepted as DRP strategies

Summary

Introduction

Frailty in the aging patient is a state of vulnerability in which health status can suddenly decrease as a result of relatively small health events (Clegg et al 2013). Frail elderly often have multiple chronic conditions which are associated with the use of many drugs. A drug-related problem (DRP) is “an event or a circumstance involving drug therapy that or potentially interferes with health care outcome” (Silva et al 2015). DRPs are associated with (frail) elderly as a consequence of polypharmacy, complex dosing regimens as well as alterations in pharmacokinetics and pharmacodynamics. DRPs are associated with cognitive and functional status (Silva et al 2015)

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