Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Pharmacy Department, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
BMC Med Inform Decis Mak. 2019 Feb 11;19(1):29. doi: 10.1186/s12911-019-0748-5.
To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called "Check of Medication Appropriateness" (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. The aim of this study is twofold: 1) describing the development of CMA and 2) evaluating the preliminary results, more specifically the number of clinical rule alerts, number of actions on the alerts and acceptance rate by physicians.
CMA focuses on patients at risk for potentially inappropriate medication and involves the daily checking by a pharmacist of high-risk prescriptions generated by advanced clinical rules integrating patient specific characteristics with details on medication. Pharmacists' actions are performed by adding an electronic note in the patients' medical record or by contacting the physician by phone. A retrospective observational study was performed to evaluate the primary outcomes during an 18-month study period.
39,481 clinical rule alerts were checked by pharmacists for which 2568 (7%) electronic notes were sent and 637 (1.6%) phone calls were performed. 37,782 (96%) alerts were checked within four pharmacotherapeutic categories: drug use in renal insufficiency (25%), QTc interval prolonging drugs (11%), drugs with a restricted indication or dosing (14%) and overruled very severe drug-drug interactions (50%). The emergency department was a frequently involved ward and anticoagulants are the drug class for which actions are most frequently carried out. From the 458 actions performed for the four abovementioned categories, 69% were accepted by physicians.
These results demonstrate the added value of CMA to support medication surveillance in synergy with already integrated basic clinical decision support and bedside clinical pharmacy. Otherwise, the study also highlighted a number of limitations, allowing improvement of the service.
为了改善莱顿大学医院的药物监测并提供药物治疗支持，开发了一个名为“药物适宜性检查”（CMA）的后台临床服务，该服务包括基于临床规则的药物不适宜性筛查。本研究的目的有两个：1）描述 CMA 的开发过程；2）评估初步结果，特别是临床规则警报的数量、对警报的处理数量以及医生的接受率。
CMA 专注于存在潜在不适当用药风险的患者，涉及药剂师每天检查由高级临床规则生成的高风险处方，这些规则整合了患者的具体特征和药物细节。药剂师的操作是通过在患者的医疗记录中添加电子注释或通过电话联系医生来完成的。为了评估主要结果，进行了一项回顾性观察研究，研究期间为 18 个月。
药剂师共检查了 39481 次临床规则警报，其中发送了 2568 次（7%）电子注释，进行了 637 次（1.6%）电话联系。在四个药物治疗类别中，有 37782 次（96%）警报在四个药物治疗类别中得到了检查：肾功能不全（25%）、QTc 间期延长药物（11%）、适应证或剂量受限的药物（14%）以及药物相互作用严重程度被推翻的药物（50%）。急诊是经常涉及的病房，而抗凝剂是最常进行处理的药物类别。在针对上述四个类别的 458 次处理中，有 69%得到了医生的认可。
这些结果表明，CMA 在与已经集成的基本临床决策支持和床边临床药学协同工作时，可以为药物监测提供附加值。此外，该研究还突出了一些局限性，从而可以改进该服务。
