A dver se D r ug E vents ( A D E s) - Any injury secondary to medication use. - Divided into: 1. Non-preventable - inherently associated with medication therapy 2. Preventable - those that cause injury to the patient that could have been prevented. 3. Potential - an ADE that could have occurred as a result of an error but (fortunately) did not.
Clinical Decision Support SystemTerms Datum - plural form “data” - the value of a specific parameter for a specific object Knowledge – derived from the formal or informal analysis of data Data base – a collection of individual observations without any summarizing analysis. Knowledge based system - the result when knowledge is applied to a system or database.
Clinical Decision Support System (CDSS)- software that is designed to be adirect aid to clinical decision-making- convert patient data essential for the clinician to make the right decisions into usable information at the time of decision making.
Why is there a need for Decision Support Systems?• Increasing number of scientific articles produced each year makes it difficult for clinicians doing research, to access the right information among the massive volumes of research.• Medical and medication errors are often the result of poorly designed system, thus the conclusion that health care facilities should rely more on automation to make it less error prone.• Computerization has lead to increase of patient- specific data that can be used in decision support algorithms.
• Focus on quality of care and the increased availability of electronic data have resulted in greater performance requirements for health care organization• Decision Support could improve the performance of Pharmacy information system by integrating additional patient specific information, resulting in more clinically relevant recommendations
Elements if CDSS • Knowledge base Translates scientific knowledge into computer- interpretable decision algorithms • Rules engine Retrieves patient-specific, often stored in multiple databases, and checks whether the criteria set in the knowledge base are met. • Software Allows the user to create clinical decision algorithms and generate recommendations
Elements of a CDSS (diagram) BCMA Laboratory Guidelines Rules software Knowledge DATA Engine baseCPOE softwareInfusion Data EKG Monitoring Output to user
f S S o D s C e n p i ym t e 1. System for diagnosis 4 t 2. Reminder systems for Prevention s 3. Systems for Disease Management ys 4. Systems for Drug Dosing and Prescribing - 2 categories: a. Basic CDSS b. Advanced CDSS
Basic CDSS- Includes the following: Drug allergy checking - presents an alert when a clinician orders a medication to which the patient has an electronically documented allergy - considered as an important patient safety feature. Basic Dosing Guidance - basic decision support, even within CPOE can dramatically improve appropriate dosage of medication by providing the clinician a list of the ff: 1. patient-specific dosage parameters. 2. drug-specific dosage parameter 3. indication-specific dosage parameters
- this often occurs in the following situations: a. patients with more than one clinician b. switching IV therapy to oral therapy without discontinuing the original IV order c. prescribing multiple drugs from the same drug class (antimicrobials, opioids, immunosuppressant, and insulin) d. dosage tapering with different doses for the same drug- extensive customization of duplicate order checking and selective alerting are needed to prevent excessive irrelevant alerting.
Formulary Decision Support - a formulary is a selection of drugs covering all therapeutic areas that can be used in the hospital. - basic decision support can improve formulary compliance by assisting clinicians in the selection of formulary options over non-formulary options. Duplicate Therapy Checking - duplicate therapy occurs when more than one regimen of a single drug or multiple regimens of different medications with similar therapeutic effects are prescribed.
Drug-Drug Interaction Checking - one of the most frequently used types of CDSS. - however, as with duplicate order checking, drug-drug interaction checking is associated with large numbers of clinically unimportant alerts.
Advanced Clinical Decision Support- Advanced medication-related decision support should be implemented only after basic decision support is in place and working well, with good user acceptance.- require many factors to determine accurately what is a safe and appropriate dosage for a particular patient.- These factors are: age renal function weight liver function height fluid status indication for the drug concomitant medications genetic predisposition reaction to previous medications
- Advanced CDSS includes the ff. subcategories: Dosing support in special populations - advanced decision support can integrate the parameters for dosage recommendations in certain cases. - this program substantially decreased the number of adverse events, number of days of unnecessary therapy, and costs. Drug-Laboratory interaction checking - decision support remind physicians to request the appropriate blood samples at the appropriate time.
Drug-Disease (contraindication) checking - the most important contraindications are renal impairment and hepatic impairment Drug pregnancy checking - an important category of advanced decision support, whose biggest challenge would be to determine the pregnancy status of the patient accurately. - electronic health records should allow clinicians to document the pregnancy status explicitly (is pregnant, might be pregnant, etc.)