de Wit Hugo A J M, Mestres Gonzalvo Carlota, Cardenas Jenny, Derijks Hieronymus J, Janknegt Rob, van der Kuy Paul-Hugo M, Winkens Bjorn, Schols Jos M G A
Department of Clinical Pharmacy and Toxicology, Atrium-Orbis Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands.
Hospital Pharmacy ZANOB, Henri Dunantstraat 1, 5223GZ 's-Hertogenbosch, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.
Int J Med Inform. 2015 Jun;84(6):396-405. doi: 10.1016/j.ijmedinf.2015.02.004. Epub 2015 Feb 19.
To improve the current standalone pharmacy clinical decision support system (CDSS) by identifying and quantifying the benefits and limitations of the system.
Alerts and handling of the executed clinical rules were extracted from the CDSS from the period September 2011 to December 2011. The number of executed clinical rule alerts, number of actions on alerts, and the reason why alerts were classified as not relevant were analyzed. The alerts where considered clinically relevant when the pharmacist needed to contact the physician.
The 4065 alerts have been separated into: 1137 (28.0%) new alerts, 2797 (68.8%) repeat alerts and 131 (3.2%) double alerts. When the alerts were analyzed, only 3.6% were considered clinically relevant. Reasons why alerts were considered as not to be relevant were: (a) the dosage was correct or already adjusted, (b) the drug was (temporarily) stopped and (c) the monitored laboratory value or drug dosage had already reverted to be within the reference limits. The reasons for no action were linked to three categorical limitations of the used system: 'algorithm alert criteria', 'CDSS optimization', and 'data delivery'.
This study highlighted a number of ways in which the CDSS could be improved. These different aspects have been identified as important for developing an efficient CDSS.
通过识别和量化当前独立药房临床决策支持系统（CDSS）的益处和局限性来改进该系统。
从2011年9月至2011年12月期间的CDSS中提取已执行临床规则的警报及处理情况。分析已执行临床规则警报的数量、对警报采取的行动数量以及警报被分类为不相关的原因。当药剂师需要联系医生时，这些警报被视为具有临床相关性。
4065条警报被分为：1137条（28.0%）新警报、2797条（68.8%）重复警报和131条（3.2%）双重警报。在分析这些警报时，只有3.6%被认为具有临床相关性。警报被视为不相关的原因有：（a）剂量正确或已调整，（b）药物（暂时）停用，（c）监测的实验室值或药物剂量已恢复到参考范围内。未采取行动的原因与所使用系统的三个分类局限性相关：“算法警报标准”、“CDSS优化”和“数据传递”。
本研究突出了一些可改进CDSS的方法。这些不同方面已被确定为开发高效CDSS的重要因素。
