Assessing the strengths and weaknesses of a computer assisted medication review in hospitalized patients


Assessing the strengths and weaknesses of a computer assisted medication review in hospitalized patient


Kim P.G.M. Hurkens1, Carlota Mestres-Gonzalvo2, Hugo A.J.M. de Wit2, Rob Janknegt2, Frans Verhey3, Jos M.G.A. Schols 4,6, Fabienne Magdelijns 5, Coen D.A. Stehouwer5,6, Bjorn Winkens 6, 7, Wubbo Mulder5 and P. Hugo M. van der Kuy2

1Department of Internal Medicine, section of Geriatric Medicine, Zuyderland Medical Centre, PO box 5500, Sittard-Geleen-Heerlen, the Netherlands;
2Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, PO box 5500, Sittard-Geleen-Heerlen, the Netherlands;
3Alzheimer Centre Limburg, School of Mental Health and Neuroscience, Maastricht University Medical Centre, PO box 5800, Maastricht, the Netherlands;
4Department of Family Medicine and Department Health Services Research, Maastricht University Medical Centre, PO box 616, 6200 MD Maastricht, the Netherlands;
5Department of Internal Medicine, Maastricht University Medical Centre, PO box 5800, Maastricht, the Netherlands;
6School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, PO box 616, 6200 MD Maastricht, the Netherlands;
7Department of Methodology and Statistics, Maastricht University Medical Centre, PO box 616, 6200 MD Maastricht, the Netherlands.


International Journal of Hospital Pharmacy

Introduction Medication reviews are an essential part of daily routine at a hospital ward but are prone to mistakes. With this study we want to assess the strengths and weaknesses of a Clinical Decision Support System (CDSS) and evaluate the additional value on the reduction of medication errors compared with manual medication reviews.
Materials and Methods We gathered all remarks related to (potential) errors in the current medication regime (notifications) regarding medication errors for 332 patients from 12 grand rounds of the internal medicine ward and orthopedic ward at the Maastricht University Medical Centre during four months. Simultaneously, we electronically extracted data regarding the patient’s medication list, laboratory data and patient characteristics and entered these data into our CDSS.
Results and Discussion One hundred thirty-eight notifications were made during grand rounds. One-hundred and seventy-nine relevant alerts were reported by the CDSS. Only three of the relevant notifications were reported by both. Overall, errors regarding indication without medication and medication without indication were most frequently noticed during grand rounds and contraindications or side effects were most frequently noticed by the CDSS. The CDSS may be a relevant addition to the manual performed medication reviews in the hospital. The strength of the present CDSS lies in the detection of errors regarding contraindications and side effects. Future developments include optimizing the cut off values at which the CDSS should provide an alert is an important next step in improving the CDSS. Additionally, in order to increase notifications about indication without medication and medication without indication, the medical history should be incorporated into the CDSS. Finally, relevance on patient outcome should be determined.

 Keywords: Clinical decision support system, clinical rules, medication review, medication safety, polypharmacy


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How to cite this article:
Hurkens et al.,. Assessing the strengths and weaknesses of a computer assisted medication review in hospitalized patients. International Journal of Hospital Pharmacy, 2017,2:6. DOI: 10.28933/IJHP-2017-10-0101


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