Department of Geriatric Medicine, Laurentius Hospital, 6040 AX, Roermond, PO box 920, The Netherlands.
Department of Hospital Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands.
BMC Geriatr. 2024 Mar 14;24(1):256. doi: 10.1186/s12877-024-04823-7.
Drug-related problems (DRPs) and potentially inappropriate prescribing (PIP) are associated with adverse patient and health care outcomes. In the setting of hospitalized older patients, Clinical Decision Support Systems (CDSSs) could reduce PIP and therefore improve clinical outcomes. However, prior research showed a low proportion of adherence to CDSS recommendations by clinicians with possible explanatory factors such as little clinical relevance and alert fatigue.
To investigate the use of a CDSS in a real-life setting of hospitalized older patients. We aim to (I) report the natural course and interventions based on the top 20 rule alerts (the 20 most frequently generated alerts per clinical rule) of generated red CDSS alerts (those requiring action) over time from day 1 to 7 of hospitalization; and (II) to explore whether an optimal timing can be defined (in terms of day per rule).
All hospitalized patients aged ≥ 60 years, admitted to Zuyderland Medical Centre (the Netherlands) were included. The evaluation of the CDSS was investigated using a database used for standard care. Our CDSS was run daily and was evaluated on day 1 to 7 of hospitalization. We collected demographic and clinical data, and moreover the total number of CDSS alerts; the total number of top 20 rule alerts; those that resulted in an action by the pharmacist and the course of outcome of the alerts on days 1 to 7 of hospitalization.
In total 3574 unique hospitalized patients, mean age 76.7 (SD 8.3) years and 53% female, were included. From these patients, in total 8073 alerts were generated; with the top 20 of rule alerts we covered roughly 90% of the total. For most rules in the top 20 the highest percentage of resolved alerts lies somewhere between day 4 and 5 of hospitalization, after which there is equalization or a decrease. Although for some rules, there is a gradual increase in resolved alerts until day 7. The level of resolved rule alerts varied between the different clinical rules; varying from > 50-70% (potassium levels, anticoagulation, renal function) to less than 25%.
This study reports the course of the 20 most frequently generated alerts of a CDSS in a setting of hospitalized older patients. We have shown that for most rules, irrespective of an intervention by the pharmacist, the highest percentage of resolved rules is between day 4 and 5 of hospitalization. The difference in level of resolved alerts between the different rules, could point to more or less clinical relevance and advocates further research to explore ways of optimizing CDSSs by adjustment in timing and number of alerts to prevent alert fatigue.
药物相关问题（DRPs）和潜在不适当的处方（PIP）与患者和医疗保健结果不良有关。在住院老年患者中，临床决策支持系统（CDSS）可以减少 PIP，从而改善临床结果。然而，先前的研究表明，临床医生对 CDSS 建议的依从性较低，可能的解释因素包括临床相关性较小和警报疲劳。
在住院老年患者的真实环境中研究 CDSS 的使用。我们的目标是（I）报告基于生成的红色 CDSS 警报（需要采取行动的警报）的前 20 条规则警报（每个临床规则中最常生成的 20 条警报）在住院的第 1 天到第 7 天的自然过程和干预措施；（II）探索是否可以定义最佳时间（按规则天数）。
纳入所有年龄≥60 岁、入住 Zuyderland 医疗中心（荷兰）的住院患者。使用用于标准护理的数据库评估 CDSS。我们的 CDSS 每天运行，并在住院的第 1 天至第 7 天进行评估。我们收集了人口统计学和临床数据，以及 CDSS 警报的总数；前 20 条规则警报的总数；那些导致药剂师采取行动的警报，以及住院第 1 天至第 7 天警报的结果。
共纳入 3574 名独特的住院患者，平均年龄 76.7（SD 8.3）岁，53%为女性。从这些患者中，共生成了 8073 个警报；前 20 名规则警报涵盖了大约 90%的总警报。对于前 20 名中的大多数规则，解决警报的最高百分比位于住院的第 4 天到第 5 天之间，之后则趋于均衡或减少。尽管对于某些规则，解决警报的百分比直到第 7 天逐渐增加。解决规则警报的水平因不同的临床规则而异；从 >50-70%（钾水平、抗凝、肾功能）到低于 25%不等。
本研究报告了在住院老年患者环境中 CDSS 中最常生成的 20 个警报的过程。我们表明，对于大多数规则，无论药剂师是否进行干预，解决规则的最高百分比在住院的第 4 天到第 5 天之间。不同规则之间解决警报的水平差异可能表明临床相关性或多或少，并提倡进一步研究通过调整警报的时间和数量来优化 CDSS，以防止警报疲劳。
