title: A clinical data warehouse-based process for refining medication orders alerts.
abstract: The objective of this case report is to evaluate the use of a clinical data warehouse coupled with a clinical information system to test and refine alerts for medication orders control before they were fully implemented. A clinical decision rule refinement process was used to assess alerts. The criteria assessed were the frequencies of alerts for initial prescriptions of 10 medications whose dosage levels depend on renal function thresholds. In the first iteration of the process, the frequency of the 'exceeds maximum daily dose' alerts was 7.10% (617/8692), while that of the 'under dose' alerts was 3.14% (273/8692). Indicators were presented to the experts. During the different iterations of the process, 45 (16.07%) decision rules were removed, 105 (37.5%) were changed and 136 new rules were introduced. Extensive retrospective analysis of physicians' medication orders stored in a clinical data warehouse facilitates alert optimization toward the goal of maximizing the safety of the patient and minimizing overridden alerts.
authors.affiliation: Paris Descartes University (Paris 5), Paris, France. abdelali.boussadi@egp.aphp.fr
authors.forename: Abdelali
authors.initials: A
authors.lastname: Boussadi
authors.forename: Thibaut
authors.initials: T
authors.lastname: Caruba
authors.forename: Eric
authors.initials: E
authors.lastname: Zapletal
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sabatier
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.forename: Patrice
authors.initials: P
authors.lastname: Degoulet
mesh_terms: D016208:Databases, Factual; D003661:Decision Support Techniques; D054796:Drug Dosage Calculations; D005602:France; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data*; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D019982:Organizational Case Studies; D017010:Reminder Systems; D051437:Renal Insufficiency; D012986:Software Validation