The impact of the bedside check of medication appropriateness (BED-CMA) at the hematology ward: a mixed-methods study.

BACKGROUND

Hematology patients have complex medication regimens and rapidly changing organ function, rendering them susceptible to medication errors. Health information technology can facilitate the detection of inappropriate prescriptions and assist healthcare professionals in enhancing patient safety.

AIM

To evaluate the impact of a pharmacist-oriented clinical decision support system, called Bedside Check of Medication Appropriateness (BED-CMA), on inappropriate prescribing at the hematology ward, and to qualitatively assess its impact on the organization of bedside clinical pharmacy practice.

METHOD

A mixed-methods study was conducted at the semi-critical 15-bed hematology ward of UZ Leuven between 2020 and 2023. A pre-post study was performed to evaluate the impact of BED-CMA on residual potentially inappropriate prescriptions (PIPs), defined as those that persisted for at least 24 h after their initial identification. A time trend analysis was performed to identify any potential pre-existing patterns. The BED-CMA intervention consisted of embedding 19 clinical rules into the hospital information system. The pre-intervention cohort received usual clinical pharmacy services. Post-intervention, clinical pharmacists used BED-CMA alerts in addition to standard practices. A focus group discussion with clinical pharmacists assessed the impact on the organization of bedside clinical pharmacy practice.

RESULTS

Pre-intervention, 70% (48/69) of initial PIPs remained residual PIPs, which decreased to 20% (13/66) post-intervention (odds ratio 0.11 (95% confidence interval 0.05-0.22, P < .0.0001)). There was no evidence for a pre-existing time trend (P = .0.52). Pharmacists reported improved workflow efficiency through enhanced patient prioritization and prompt identification of PIPs.

CONCLUSION

BED-CMA significantly reduced residual PIPs by streamlining clinical pharmacy practice at a hematology ward.