title: [Drug-related interventions made through a computerized prescription order entry system in an Internal Medicine unit].
abstract: BACKGROUND
  The objective of this article is to describe the drug-related interventions made in the prescriptions with a computerized order entry system and to determine their frequency and clinical relevance in order to propose improvement actions.
  
  
  METHODS
  Observational descriptive study. Drug-related interventions made in the inpatient's prescriptions of an Internal Medicine unit from January to May of 2007 were analyzed and recorded. The frequency of the intervention causes and of the drugs involved was determined.The clinical significance and impact of the recommendations were also determined.
  
  
  RESULTS
  A total of 441 interventions were recorded, 0.73 per patient. The most frequent was the proposal of intravenous to oral conversion (45%), mainly with acetaminophen (63%) and protons pump inhibitors (24%). This was followed by replacement of drugs not included in the guide (15% of interventions), mainly involving cardiovascular and central nervous system drugs (23% each one). Educational actions proposed included a campaign to promote intravenous to oral conversion and a program involving therapeutic equivalent replacement. The most clinically significant interventions were due to dosage errors, therapeutic duplicities, off label medications and adverse events. A proposal was made to include a new module in the medical order entry system that alerts on the established maximum doses for each drug, and new protocols for the treatment of certain conditions. Sixty percent of the interventions achieved an improvement in efficiency.
  
  
  CONCLUSIONS
  We conclude that drug therapy intervention analysis can identify items that can be improved, set educational actions for physicians and new protocols for certain conditions. Innovative actions can be introduced into the medical order entry system in order to improve drug safety.
authors.affiliation: Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, España. mduran.hgugm@salud.madrid.org
authors.forename: M E
authors.initials: ME
authors.lastname: Durán García
authors.forename: C
authors.initials: C
authors.lastname: Pérez Sanz
authors.forename: A B
authors.initials: AB
authors.lastname: Jiménez Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Giménez Manzorro
authors.forename: A
authors.initials: A
authors.lastname: Muiño Miguez
authors.forename: L A
authors.initials: LA
authors.lastname: Alvarez-Sala Walter
authors.forename: M
authors.initials: M
authors.lastname: Sanjurjo Sáez
mesh_terms: D006757:Hospital Units; D006801:Humans; D007388:Internal Medicine; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*