title: Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists' analysis of medication orders in hospitals.
abstract: OBJECTIVE
  The main objective of this study was to assess the diagnostic performances of an alert system integrated into the CPOE/EMR system for renally cleared drug dosing control. The generated alerts were compared with the daily routine practice of pharmacists as part of the analysis of medication orders.
  
  
  METHODS
  The pharmacists performed their analysis of medication orders as usual and were not aware of the alert system interventions that were not displayed for the purpose of the study neither to the physician nor to the pharmacist but kept with associate recommendations in a log file. A senior pharmacist analyzed the results of medication order analysis with and without the alert system. The unit of analysis was the drug prescription line. The primary study endpoints were the detection of drug dose prescription errors and inter-rater reliability (Kappa coefficient) between the alert system and the pharmacists in the detection of drug dose error.
  
  
  RESULTS
  The alert system fired alerts in 8.41% (421/5006) of cases: 5.65% (283/5006) "exceeds max daily dose" alerts and 2.76% (138/5006) "under-dose" alerts. The alert system and the pharmacists showed a relatively poor concordance: 0.106 (CI 95% [0.068-0.144]). According to the senior pharmacist review, the alert system fired more appropriate alerts than pharmacists, and made fewer errors than pharmacists in analyzing drug dose prescriptions: 143 for the alert system and 261 for the pharmacists. Unlike the alert system, most diagnostic errors made by the pharmacists were 'false negatives'. The pharmacists were not able to analyze a significant number (2097; 25.42%) of drug prescription lines because understaffing.
  
  
  CONCLUSIONS
  This study strongly suggests that an alert system would be complementary to the pharmacists' activity and contribute to drug prescription safety.
authors.affiliation: Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Département d'Informatique Hospitalière - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; UPMC University (Paris 06), Paris, France. Electronic address: abdelali.boussadi@egp.aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Boussadi
authors.affiliation: Service de Pharmacie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; LIRAES EA 4470, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Caruba
authors.affiliation: Service de Néphrologie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Karras
authors.affiliation: Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Service de Pharmacie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; UPMC University (Paris 06), Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Berdot
authors.affiliation: Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Département d'Informatique Hospitalière - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Degoulet
authors.affiliation: Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Département d'Informatique Hospitalière - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Durieux
authors.affiliation: Paris Descartes University (Paris 5), Paris, France; INSERM UMR_S 872 Eq 22, Paris, France; Service de Pharmacie - Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Sabatier
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D016303:Clinical Pharmacy Information Systems / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D005602:France; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000175:diagnosis / Q000188:drug therapy*
keywords: Computer-assisted; Decision support techniques; Drug dosage calculations; Drug prescriptions; Medication errors/prevention & control; Pharmaceutical preparations/administration & dosage; Software validation