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Comparative evaluation of three clinical decision support systems: prospective screening for medication errors in 100 medical inpatients

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Clinical decision support systems (CDSS) are promoted as powerful screening tools to improve pharmacotherapy. The aim of our study was to evaluate the potential contribution of CDSS to patient management in clinical practice.

Methods

We prospectively analyzed the pharmacotherapy of 100 medical inpatients through the parallel use of three CDSS, namely, Pharmavista, DrugReax, and TheraOpt. After expert discussion that also considered all patient-specific clinical information, we selected apparently relevant alerts, issued suitable recommendations to physicians, and recorded subsequent prescription changes.

Results

For 100 patients with a median of eight concomitant drugs, Pharmavista, DrugReax, and TheraOpt generated a total of 53, 362, and 328 interaction alerts, respectively. Among those we identified and forwarded 33 clinically relevant alerts to the attending physician, resulting in 19 prescription changes. Four adverse drug events were associated with interactions. The proportion of clinically relevant alerts among all alerts (positive predictive value) was 5.7, 8.0, and 7.6%, and the sensitivity to detect all 33 relevant alerts was 9.1, 87.9, and 75.8% for Pharmavista, DrugReax and TheraOpt, respectively. TheraOpt recommended 31 dose adjustments, of which we considered 11 to be relevant; three of these were followed by dose reductions.

Conclusions

CDSS are valuable screening tools for medication errors, but only a small fraction of their alerts appear relevant in individual patients. In order to avoid overalerting CDSS should use patient-specific information and management-oriented classifications. Comprehensive information should be displayed on-demand, whereas a limited number of computer-triggered alerts that have management implications in the majority of affected patients should be based on locally customized and supported algorithms.

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Acknowledgments

The physicians at the Department of Internal Medicine at the University Hospital Zurich are gratefully acknowledged for their time and effort spent in discussing and improving the patients’ pharmacotherapy.

Financial support and conflict of interest statement

The work presented in this manuscript was carried out independently by the authors and with general resources available at the Department of Clinical Pharmacology. IC, ME, and GKU are involved in the development of prescribing software, but they have no financial associations to the CDSS studied here. All authors declare that they have no conflict of interest regarding the work presented here.

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Authors and Affiliations

  1. Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    Daniela Fritz, Alessandro Ceschi, Ivanka Curkovic, Martin Huber, Marco Egbring, Gerd A. Kullak-Ublick & Stefan Russmann

  2. Swiss Toxicological Information Center, Zurich, Switzerland

    Alessandro Ceschi

  3. Zurich Center for Integrative Human Physiology (ZIHP), Zurich, Switzerland

    Gerd A. Kullak-Ublick & Stefan Russmann

Authors
  1. Daniela Fritz
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  2. Alessandro Ceschi
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  3. Ivanka Curkovic
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  4. Martin Huber
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  5. Marco Egbring
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  7. Stefan Russmann
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Corresponding author

Correspondence to Stefan Russmann.

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Fritz, D., Ceschi, A., Curkovic, I. et al. Comparative evaluation of three clinical decision support systems: prospective screening for medication errors in 100 medical inpatients. Eur J Clin Pharmacol 68, 1209–1219 (2012). https://doi.org/10.1007/s00228-012-1241-6

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  • DOI: https://doi.org/10.1007/s00228-012-1241-6

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