Pharmacy World & Science

, 32:103 | Cite as

Electronic screening of medical records to detect inpatients at risk of drug-related problems

  • Isabelle RotenEmail author
  • Stefan Marty
  • Johnny Beney
Research Article


Objective The objective of the study is to develop and validate a screening tool for clinical pharmacists (CPs), comprising electronic queries (EQs) structured to identify inpatients at risk of drug-related problems (DRPs) [1]. Setting Internal Medicine and Geriatric Units of the (multi-site) Hôpital du Valais. Method EQs, identifying patients with potential DRPs and/or those requiring a medication review were compared with a CP-conducted manual check of all electronic medical records (EMRs), during their standard activities. The queries were aimed at identifying patients receiving drugs such as cytochrome P450 inducers, inhibitors or high-risk medications, those with renal impairment, those on digoxin with low serum potassium, those with intravenous (i.v.) anti-infectives or i.v. acetaminophen for more than 3 days, and elderly patients with polymedication (≥80 years and >10 drugs). Main outcome measure Sensitivity and specificity of the screening tool. Results Five hundred and one patients seen by 4 CPs during 36 ward rounds were screened. The EQs identified 64.7% of the visited inpatients. The CPs detected at least one DRP in 64.9% of all patients. A sensitivity of 85.1% and a specificity of 60.4% were achieved. Conclusion This tool allows for efficient and rapid screening of patients at risk of DRPs in preparation for the ward round. It helps CPs to prioritize their medication reviews and to optimize their workload.


Drug therapy Drug utilization review Medical records systems, computerized Pharmacists Pharmaceutical services Workload 



We gratefully acknowledge the assistance of Alex Gnaegi, Director of Medical and Administrative Informatics, who permitted the development of the EQs, and Thomas Antille for their translation into structured query language. The authors wish also to thank Viviane Amos and Vera von Gunten for their participation as CPs, and the pharmacy team for their critical reading of the article.



Conflicts of interest statement

The authors have no conflicts of interest to declare.


  1. 1.
    Pharmaceutical Care Network Europe. DRP-classification V5.01. 2009. Accessed Aug 2009.
  2. 2.
    Krähenbühl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krähenbühl S. Drug-related problems in hospitals—a review of the recent literature. Drug Saf. 2007;30:379–407.CrossRefPubMedGoogle Scholar
  3. 3.
    Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium—description of the impact on a geriatric unit. Ann Pharmacother. 2006;40(4):720–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Eviter les effets indésirables par interactions médicamenteuses. Prescrire, Le Guide 2008. 2007;27(290):1–208.Google Scholar
  5. 5.
    Murphy JE, Malone DC, Olson BM, Grizzle AJ, Armstrong EP, Skrepnek GH. Development of computerized alerts with management strategies for 25 serious drug–drug interactions. Am J Health Syst Pharm. 2009;66(1):38–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Harris W. Methotrexate-associated medication errors. Am J Health Syst Pharm. 2004;61(24):2635.PubMedGoogle Scholar
  7. 7.
    Moore TJ, Walsh CS, Cohen MR. Reported medication errors associated with methotrexate. Am J Health Syst Pharm. 2004;61(13):1380–4.PubMedGoogle Scholar
  8. 8.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.CrossRefPubMedGoogle Scholar
  9. 9.
    K/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 Suppl 1):S1–S266.Google Scholar
  10. 10.
    van Dijk EA, Drabbe NR, Kruijtbosch M, De Smet PA. Drug dosage adjustments according to renal function at hospital discharge. Ann Pharmacother. 2006;40(7–8):1254–60.PubMedGoogle Scholar
  11. 11.
    Wong NA, Jones HW. An analysis of discharge drug prescribing amongst elderly patients with renal impairment. Postgrad Med J. 1998;74(873):420–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Salomon L, Deray G, Jaudon MC, Chebassier C, Bossi P, Launay-Vacher V, et al. Medication misuse in hospitalized patients with renal impairment. Int J Qual Health Care. 2003;15(4):331–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Mordasini MR, Krähenbühl S, Schlienger RG. Appropriateness of digoxin level monitoring. Swiss Med Wkly. 2002;132(35–36):506–12.PubMedGoogle Scholar
  14. 14.
    Aronson JK, Hardman M. ABC of monitoring drug therapy. Digoxin. BMJ. 1992;305(6862):1149–52.CrossRefPubMedGoogle Scholar
  15. 15.
    von Gunten V, Amos V, Sidler AL, Beney J, Troillet N, Reymond JP. Hospital pharmacists’ reinforcement of guidelines for switching from parenteral to oral antibiotics: a pilot study. Pharm World Sci. 2003;25(2):52–5.CrossRefGoogle Scholar
  16. 16.
    Bensimon E, Marty S, Theytaz C, Frasseren M, Eckert P, Beney J. Réduction des coûts du paracétamol dans une unité de soins intensifs [Poster]. Quatorzièmes journées franco-suisses de pharmacie hospitalière, Lausanne, 2007.Google Scholar
  17. 17.
    Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. Qual Saf Health Care. 2003;12(3):176–80.CrossRefPubMedGoogle Scholar
  18. 18.
    Hanlon JT, Artz MB, Pieper CF, Lindblad CI, Sloane RJ, Ruby CM, et al. Inappropriate medication use among frail elderly inpatients. Ann Pharmacother. 2004;38(1):9–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Jones SR, Carley S, Harrison M. An introduction to power and sample size estimation. Emerg Med J. 2003;20(5):453–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Buderer NM. Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med. 1996;3(9):895–900.CrossRefPubMedGoogle Scholar
  21. 21.
    Bindoff IK, Tenni PC, Peterson GM, Kang BH, Jackson SL. Development of an intelligent decision support system for medication review. J Clin Pharm Ther. 2007;32(1):81–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Pharmacie des Hôpitaux du Nord Vaudois et de la BroyeYverdon-les-BainsSwitzerland
  2. 2.Pharmacie de l’Institut Central des Hôpitaux ValaisansSionSwitzerland

Personalised recommendations