Clinical-Pharmaceutical Assessment of Medication CDSS-alerts: Content Appropriateness and Patient Relevance in Clinical Practice

Jacqueline Bauer ^1* Marika Busse ^1* Sonja Koch ^1* Marina Schmid ^1* Julia Sommer ^1* Martin F. Fromm ^2,3* Frank Dörje ^1,3*

• ¹ Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
• ² Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg,, Erlangen, Germany
• ³ FAU NeW – Research Center New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

BackgroundClinical pharmacy services and Clinical Decision Support Systems [CDSS] are increasingly implemented to optimize medication safety. However, risks as overalerting can limit these benefits. Therefore, the Meona-medication-CDSS was interprofessionally evaluated and locally configured prior to implementation at Erlangen University Hospital.AimWe aimed to analyze the displayed CDSS-alerts and to evaluate the content appropriateness and patient relevance of CDSS-alerts in a hospital with already established clinical ward pharmacists. Furthermore, we characterized pharmaceutical interventions triggered by CDSS and CDSS-independent interventions.MethodsPseudonymized clinical data of 160 patients of four clinical departments were prospectively included once between day 1-3 after hospital-admission to analyze the displayed CDSS-alerts regarding their frequency, type, and severity. All severe and ‘duplicate prescription’ CDSS-alerts were evaluated regarding to their content appropriateness and patient relevance by clinical pharmacists using the four-eyes-principle. For patient relevant CDSS-alerts, the clinical ward pharmacists intervened during weekly ward rounds. All pharmaceutical interventions, including CDSS-independent interventions, were documented in ADKA-DokuPIK recording reason, acceptance rate, and severity.ResultsIn total, 1,799 CDSS-alerts (in median 9.0/patient) were displayed. Thereof, 33.9% (609/1799) were classified as severe by Meona. 647 CDSS-alerts (609 severe and 38 ‘duplicate prescriptions’) were validated by clinical pharmacists. Only 82.7% (535/647) were rated as content appropriate, of which 19.6% (105/535) were classified patient relevant. The clinical ward pharmacists recorded 244 interventions in 150 patients discussed during rounds (1.6/patient). CDSS-independent interventions by clinical ward pharmacists (158/244, 64.8%) were significantly more frequent compared to pharmaceutical interventions triggered by CDSS (86/244, 35.2%). (p=0.0002). Acceptance rate of interventions was 92.2% (225/244). The most common severity category was C (error occurred, no harm).ConclusionDespite the locally customized medication CDSS, a high number of CDSS-alerts were displayed. Interestingly, we still observed content inappropriate CDSS-alerts by pharmaceutical validation. The majority of CDSS-alerts with appropriate content were rated not patient relevant in clinical practice and could be considered as overalerting. Our results highlight that CDSS can support health care professionals, but underline (1) the continuing need of clinical pharmacists for improving medication safety by interpreting CDSS-alerts and performing comprehensive medication reviews, and (2) the further need for CDSS improvements.