Evaluation of clinical rules in a standalone pharmacy based clinical decision support system for hospitalized and nursing home patients.
OBJECTIVE
To improve the current standalone pharmacy clinical decision support system (CDSS) by identifying and quantifying the benefits and limitations of the system.


METHODS
Alerts and handling of the executed clinical rules were extracted from the CDSS from the period September 2011 to December 2011. The number of executed clinical rule alerts, number of actions on alerts, and the reason why alerts were classified as not relevant were analyzed. The alerts where considered clinically relevant when the pharmacist needed to contact the physician.


RESULTS
The 4065 alerts have been separated into: 1137 (28.0%) new alerts, 2797 (68.8%) repeat alerts and 131 (3.2%) double alerts. When the alerts were analyzed, only 3.6% were considered clinically relevant. Reasons why alerts were considered as not to be relevant were: (a) the dosage was correct or already adjusted, (b) the drug was (temporarily) stopped and (c) the monitored laboratory value or drug dosage had already reverted to be within the reference limits. The reasons for no action were linked to three categorical limitations of the used system: 'algorithm alert criteria', 'CDSS optimization', and 'data delivery'.


CONCLUSIONS
This study highlighted a number of ways in which the CDSS could be improved. These different aspects have been identified as important for developing an efficient CDSS.
Department of Clinical Pharmacy and Toxicology, Atrium-Orbis Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands. Electronic address: hu.dewit@orbisconcern.nl.
Hugo A J M
HA
de Wit
Department of Clinical Pharmacy and Toxicology, Atrium-Orbis Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands. Electronic address: c.mestresgonzalvo@orbisconcern.nl.
Carlota
C
Mestres Gonzalvo
Department of Clinical Pharmacy and Toxicology, Atrium-Orbis Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands. Electronic address: cardjenny@hotmail.com.
Jenny
J
Cardenas
Hospital Pharmacy ZANOB, Henri Dunantstraat 1, 5223GZ 's-Hertogenbosch, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands. Electronic address: j.derijks@zanob.nl.
Hieronymus J
HJ
Derijks
Department of Clinical Pharmacy and Toxicology, Atrium-Orbis Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands. Electronic address: r.janknegt@orbisconcern.nl.
Rob
R
Janknegt
Department of Clinical Pharmacy and Toxicology, Atrium-Orbis Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard-Geleen, The Netherlands. Electronic address: h.vanderkuy@orbisconcern.nl.
Paul-Hugo M
PH
van der Kuy
Department of Methodology and Statistics, CAPHRI-School for Public Health and Primary Care, Maastricht University, Peter Debeyeplein 1, 6229 HA Maastricht, The Netherlands. Electronic address: bjorn.winkens@maastrichtuniversity.nl.
Bjorn
B
Winkens
Department of Family Medicine, CAPHRI-School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of Health Services Research, CAPHRI-School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands. Electronic address: jos.schols@maastrichtuniversity.nl.
Jos M G A
JM
Schols
D000465:Algorithms; D016303:Clinical Pharmacy Information Systems; D020000:Decision Support Systems, Clinical; D006761:Hospitals; D006801:Humans; D050316:Medical Order Entry Systems; D009735:Nursing Homes
Algorithms; Clinical decision support systems; Decision support techniques; Efficiency