title: The support of medication reviews in hospitalised patients using a clinical decision support system.
abstract: OBJECTIVE
  First, to estimate the added value of a clinical decision support system (CDSS) in the performance of medication reviews in hospitalised elderly. Second, to identify the limitations of the current CDSS by analysing generated drug-related problems (DRPs).
  
  
  METHODS
  Medication reviews were performed in patients admitted to the geriatric ward of the Zuyderland medical centre. Additionally, electronically available patient information was introduced into a CDSS. The DRP notifications generated by the CDSS were compared with those found in the medication review. The DRP notifications were analysed to learn how to improve the CDSS.
  
  
  RESULTS
  A total of 223 DRP strategies were identified during the medication reviews. The CDSS generated 70 clinically relevant DRP notifications. Of these DRP notifications, 63 % (44) were also found during the medication reviews. The CDSS generated 10 % (26) new DRP notifications and conveyed 28 % (70) of all 249 clinically relevant DRPs that were found. Classification of the CDSS generated DRP notifications related to 'medication error type' revealed that 'contraindications/interactions/side effects' and 'indication without medication' were the main categories not identified during the manual medication review. The error types 'medication without indication', 'double medication', and 'wrong medication' were mostly not identified by the CDSS.
  
  
  CONCLUSIONS
  The CDSS used in this study is not yet sufficiently advanced to replace the manual medication review, though it does add value to the manual medication review. The strengths and weaknesses of the current CDSS can be determined according to the medication error types.
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
authors.forename: Hugo A J M
authors.initials: HA
authors.lastname: de Wit
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Kim P G M
authors.initials: KP
authors.lastname: Hurkens
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Carlota
authors.initials: C
authors.lastname: Mestres Gonzalvo
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Machiel
authors.initials: M
authors.lastname: Smid
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Walther
authors.initials: W
authors.lastname: Sipers
authors.affiliation: Department of Methodology and Statistics, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Wubbo J
authors.initials: WJ
authors.lastname: Mulder
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Janknegt
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg/School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frans R
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
authors.forename: Paul-Hugo M
authors.initials: PH
authors.lastname: van der Kuy
authors.affiliation: Department of General Practice and Department of Health Services Research, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
keywords: Clinical decision support systems; Geriatrics; Medication errors