Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals

OBJECTIVES: To determine the frequency of clinical decision support system (CDSS) medication-related alerts generated, accepted, or overridden, to assess appropriateness of alert display and overrides, and to characterise the documentation of clinician justification for these overrides in an academic medical centre in Saudi Arabia. MATERIALS AND METHODS: System-generated CDSS reports for the period June 2015 to December 2017 were retrospectively reviewed and analysed. Alerts were classified into different types, and rates of alert overrides calculated as percentages of all generated alerts. A subset of 307 overridden alerts was assessed for appropriateness of display and override by two clinical pharmacists. Physician documentation of reasons for overriding alerts were categorised. RESULTS: A total of 4,446,730 medication-related alerts were generated from both inpatient and outpatient settings, and 4,231,743 (95.2%) were overridden. The most common alert type was 'duplicate drug', accounting for 3,549,736 (79.8%) of alerts. Of 307 alerts assessed for appropriateness, 246 (80%) were judged to be appropriately displayed and 244 (79%) were overridden appropriately. New drug allergy and drug allergy alerts had the highest percentage of being judged as inappropriately overridden. For 1,594,313 alerts (37.7%), 'no overridden reason selected' was chosen from the drop-down menu. CONCLUSIONS: The alert generation and override rate were higher than reported previously in the literature. The small sample size of 307 alerts assessed for appropriateness of alert display and override is a potential limitation. Revision of the CDSS rules for alerts (focusing on specificity and relevance for the local context) is now recommended. Future research should prospectively assess providers' perspectives, and determine patient harm associated with overridden alerts

Risk of Drug-Drug Interactions in Out-Hospital Drug Dispensings in France: Results From the DRUG-Drug Interaction Prevalence Study

Introduction: Drug interactions could account for 1% of hospitalizations in the general population and 2–5% of hospital admissions in the elderly. However, few data are available on the drugs concerned and the potential severity of the interactions encountered. We thus first aimed to estimate the prevalence of dispensings including drugs Contraindicated or Discommended because of Interactions (CDI codispensings) and to identify the most frequently involved drug pairs. Second, we aimed to investigate whether the frequency of CDI codispensings appeared higher or lower than the expected for the drugs involved.Methods: We carried out a study using a random sample of all drugs dispensings registered in a database of the French Health Insurance System between 2010 and 2015. The distribution of the drugs involved was described considering active principles, detailing the 20 most frequent ones for both contraindicated or discommended codispensings (DCs). To investigate whether the frequency of CDI codispensings appeared higher or lower than the expected for the drugs involved, we developed a specific indicator, the Drug-drug interaction prevalence study-score (DIPS-score), that compares for each drug pair the observed frequency of codispensing to its expected probability. The latter is determined considering the frequencies of dispensings of the individual drugs constituting a pair of interest.Results: We analyzed 6,908,910 dispensings: 13,196 (0.2%) involved contraindicated codispensings (CCs), and 95,410 (1.4%) DCs. For CCS, the most frequently involved drug pair was “bisoprolol+flecainide” (n = 5,036); four out of five of the most represented pairs involved cardiovascular drugs. For DCS, the most frequently involved drug pair was “ramipril+spironolactone” (n = 4,741); all of the five most represented pairs involved cardiovascular drugs. The drug pair involved in the CC with the highest score value was “citalopram+hydroxyzine” (DIPS-score: 3.7; 2.9–4.6); that with the lowest score was “clarithromycin+simvastatin” (DIPS-score: 0.2; 0.2–0.3). DIPS-score median value was 0.4 for CCs and 0.6 for DCs.Conclusion: This high prevalence of CDI codispensings enforces the need for further risk-prevention actions regarding drug-drug interactions (DDIs), especially for arrhythmogenic or anti-arrhythmic drugs. In this perspective, the DIPS-score we develop could ease identifying the interactions that are poorly considered by clinicians/pharmacists and targeting interventions

Computerized Clinical Decision Support Systems for decision support in patients with breast, lung, colorectal or prostate cancer

Sistemes electrònics; Càncer; Presa de decisionsSistemas electrónicos; Cáncer; Toma de decisionesElectronic systems; Cancer; Decision makingEl objetivo general de este informe de ETS es evaluar la seguridad, eficacia, efectividad y eficiencia de los sistemas electrónicos de apoyo a las decisiones clínicas (computerized Clinical Decision Support Systems o cCDSS), específicamente de los considerados de nivel medio (p. ej. calculadoras pronósticas o GPC automatizadas) y de nivel alto (aquellos que utilizan la IA para formular recomendaciones específicas para un paciente), para el apoyo a la toma de decisiones clínicas relativas al manejo terapéutico, seguimiento o pronóstico de pacientes con cáncer de mama, pulmón, colon-recto o próstata. También se propone evaluar el impacto de los cCDSS en cáncer a nivel organizativo, legal, ético y social/de pacientes.L'objectiu general d'aquest informe d'ETS és avaluar la seguretat, eficàcia, efectivitat i eficiència dels sistemes electrònics de suport a les decisions clíniques (computeritzed Clinical Decision Support Systems o cCDSS), específicament dels considerats de nivell mitjà (p. ex. calculadores pronòstiques o GPC automatitzades) i de nivell alt (aquells que utilitzen la IA per formular recomanacions específiques per a un pacient), per al suport a la presa de decisions clíniques relatives al maneig terapèutic, seguiment o pronòstic de pacients amb càncer de mama, pulmó, còlon-recte o pròstata. També es proposa avaluar l'impacte dels cCDSS en càncer a nivell organitzatiu, legal, ètic i social/de pacients.The overall objective of this HTA report is to evaluate the safety, efficacy, effectiveness, and efficiency of (computeritzed Clinical Decision Support Systems (cCDSS), specifically those considered medium level (e.g. prognostic calculators or automated CPGs) and high level (those that use AI to formulate patient-specific recommendations), for clinical decision support regarding the therapeutic management, follow-up, or prognosis of patients with breast, lung, colon-rectum or prostate cancer. It is also proposed to assess the impact of cCDSS in cancer at organizational, legal, ethical, and social/patient level