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