title: Substantial reduction of inappropriate tablet splitting with computerised decision support: a prospective intervention study assessing potential benefit and harm.
abstract: BACKGROUND
  Currently ambulatory patients break one in four tablets before ingestion. Roughly 10% of them are not suitable for splitting because they lack score lines or because enteric or modified release coating is destroyed impairing safety and effectiveness of the medication. We assessed impact and safety of computerised decision support on the inappropriate prescription of split tablets.
  
  
  METHODS
  We performed a prospective intervention study in a 1680-bed university hospital. Over a 15-week period we evaluated all electronically composed medication regimens and determined the fraction of tablets and capsules that demanded inappropriate splitting. In a subsequent intervention phase of 15 weeks duration for 10553 oral drugs divisibility characteristics were indicated in the system. In addition, an alert was generated and displayed during the prescription process whenever the entered dosage regimen demanded inappropriate splitting (splitting of capsules, unscored tablets, or scored tablets unsuitable for the intended fragmentation).
  
  
  RESULTS
  During the baseline period 12.5% of all drugs required splitting and 2.7% of all drugs (257/9545) required inappropriate splitting. During the intervention period the frequency of inappropriate splitting was significantly reduced (1.4% of all drugs (146/10486); p = 0.0008). In response to half of the alerts (69/136) physicians adjusted the medication regimen. In the other half (67/136) no corrections were made although a switch to more suitable drugs (scored tablets, tablets with lower strength, liquid formulation) was possible in 82% (55/67).
  
  
  CONCLUSIONS
  This study revealed that computerised decision support can immediately reduce the frequency of inappropriate splitting without introducing new safety hazards.
authors.affiliation: Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, 69120 Heidelberg, Germany. renate.quinzler@med.uni-heidelberg.de
authors.forename: Renate
authors.initials: R
authors.lastname: Quinzler
authors.forename: Simon P W
authors.initials: SP
authors.lastname: Schmitt
authors.forename: Maria
authors.initials: M
authors.lastname: Pritsch
authors.forename: Jens
authors.initials: J
authors.lastname: Kaltschmidt
authors.forename: Walter E
authors.initials: WE
authors.lastname: Haefeli
mesh_terms: D002214:Capsules / Q000008:administration & dosage*; D003661:Decision Support Techniques; D004305:Dose-Response Relationship, Drug; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D008510:Medication Systems, Hospital; D055553:Prescription Drugs / Q000008:administration & dosage*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013607:Tablets / Q000008:administration & dosage*
chemical_list: D002214:Capsules; D055553:Prescription Drugs; D013607:Tablets