Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists' analysis of medication orders in hospitals

A Boussadi; T Caruba; A Karras; S Berdot; P Degoulet; P Durieux; B Sabatier

doi:10.1016/j.ijmedinf.2013.06.006

Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists' analysis of medication orders in hospitals

Int J Med Inform. 2013 Oct;82(10):964-72. doi: 10.1016/j.ijmedinf.2013.06.006. Epub 2013 Jul 5.

Authors

A Boussadi¹, T Caruba², A Karras³, S Berdot⁴, P Degoulet⁵, P Durieux⁵, B Sabatier⁶

Affiliations

¹ Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Département d'Informatique Hospitalière - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; UPMC University (Paris 06), Paris, France. Electronic address: abdelali.boussadi@egp.aphp.fr.
² Service de Pharmacie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; LIRAES EA 4470, Paris, France.
³ Service de Néphrologie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
⁴ Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Service de Pharmacie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; UPMC University (Paris 06), Paris, France.
⁵ Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Département d'Informatique Hospitalière - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
⁶ Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Service de Pharmacie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.

PMID: 23831104
DOI: 10.1016/j.ijmedinf.2013.06.006

Abstract

Objective: The main objective of this study was to assess the diagnostic performances of an alert system integrated into the CPOE/EMR system for renally cleared drug dosing control. The generated alerts were compared with the daily routine practice of pharmacists as part of the analysis of medication orders.

Materials and methods: The pharmacists performed their analysis of medication orders as usual and were not aware of the alert system interventions that were not displayed for the purpose of the study neither to the physician nor to the pharmacist but kept with associate recommendations in a log file. A senior pharmacist analyzed the results of medication order analysis with and without the alert system. The unit of analysis was the drug prescription line. The primary study endpoints were the detection of drug dose prescription errors and inter-rater reliability (Kappa coefficient) between the alert system and the pharmacists in the detection of drug dose error.

Results: The alert system fired alerts in 8.41% (421/5006) of cases: 5.65% (283/5006) "exceeds max daily dose" alerts and 2.76% (138/5006) "under-dose" alerts. The alert system and the pharmacists showed a relatively poor concordance: 0.106 (CI 95% [0.068-0.144]). According to the senior pharmacist review, the alert system fired more appropriate alerts than pharmacists, and made fewer errors than pharmacists in analyzing drug dose prescriptions: 143 for the alert system and 261 for the pharmacists. Unlike the alert system, most diagnostic errors made by the pharmacists were 'false negatives'. The pharmacists were not able to analyze a significant number (2097; 25.42%) of drug prescription lines because understaffing.

Conclusion: This study strongly suggests that an alert system would be complementary to the pharmacists' activity and contribute to drug prescription safety.

Keywords: Computer-assisted; Decision support techniques; Drug dosage calculations; Drug prescriptions; Medication errors/prevention & control; Pharmaceutical preparations/administration & dosage; Software validation.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Adverse Drug Reaction Reporting Systems / statistics & numerical data*
Clinical Pharmacy Information Systems / statistics & numerical data
Decision Support Systems, Clinical
Drug Therapy, Computer-Assisted / methods
Drug Therapy, Computer-Assisted / statistics & numerical data
Electronic Prescribing / statistics & numerical data*
France
Humans
Medical Order Entry Systems / statistics & numerical data*
Medication Errors / prevention & control*
Medication Errors / statistics & numerical data*
Medication Systems, Hospital / statistics & numerical data*
Pharmacists / statistics & numerical data
Renal Insufficiency / diagnosis
Renal Insufficiency / drug therapy*