title: Development and evaluation of an algorithm to facilitate drug prescription for inpatients with feeding tubes.
abstract: OBJECTIVE
  We aimed to develop and evaluate an algorithm to facilitate drug switching between primary and tertiary care for patients with feeding tubes.
  
  
  METHODS
  An expert consortium developed an algorithm and applied it manually to 267 preadmission drugs of 46 patients admitted to a surgical ward of a tertiary care university hospital between June 12 and December 2, 2013, and requiring a feeding tube during their inpatient stay.
  
  
  RESULTS
  The new algorithm considered the following principles: Drugs should be ideally listed on the hospital drug formulary (HDF). Additionally, drugs should include the same ingredient instead of a therapeutic equivalent. Preferred dosage forms were appropriate liquids, followed by solid drugs with liquid administration form, and solid drugs that could be crushed and/or suspended. Of all evaluated drugs, 83.5% could be switched to suitable drugs listed on the HDF and another 6.0% to drugs available on the German drug market. Additionally, for 4.1% of the drugs, the integration of individual switching rules allowed the switch from enteric-coated to immediate-release drugs. Consequently, 6.4% of the drugs could not be automatically switched and required case-to-case decision by a clinical professional (e.g., from sustained-release to immediate-release).
  
  
  CONCLUSIONS
  The predefined principles were successfully integrated in the new algorithm. Thus, the algorithm switched more than 90% of the evaluated preadmission drugs to suitable drugs for inpatients with feeding tubes. This finding suggests that the algorithm can readily be transferred to an electronic format and integrated into a clinical decision support system.
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Lohmann
authors.forename: Julia
authors.initials: J
authors.lastname: Freigofas
authors.forename: Julian
authors.initials: J
authors.lastname: Leichsenring
authors.forename: Chantal Marie
authors.initials: CM
authors.lastname: Wallenwein
authors.forename: Walter Emil
authors.initials: WE
authors.lastname: Haefeli
authors.forename: Hanna Marita
authors.initials: HM
authors.lastname: Seidling
mesh_terms: D000465:Algorithms; D020000:Decision Support Systems, Clinical / Q000592:standards; D011307:Drug Prescriptions / Q000592:standards*; D004750:Enteral Nutrition / Q000592:standards; D005572:Formularies, Hospital as Topic / Q000592:standards*; D006801:Humans; D007297:Inpatients; D007441:Intubation, Gastrointestinal / Q000592:standards; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000592:standards
chemical_list: D004364:Pharmaceutical Preparations