Medication Surveillance in older patients clinical decision support as the next step in medication safety

2015 ◽  
Author(s):  
K.P.M.G. Hurkens
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Medication Safety ◽  
Older Patients ◽  
Clinical Decision ◽  
Medication Surveillance

scholarly journals Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation

Drugs & Aging ◽  
2019 ◽  
Vol 37 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Linda G. M. Mulder-Wildemors ◽  
Mette Heringa ◽  
Annemieke Floor-Schreudering ◽  
Paul A. F. Jansen ◽  
Marcel L. Bouvy
Keyword(s):  
Decision Support ◽  
Mixed Methods ◽  
Drug Use ◽  
Community Pharmacy ◽  
Clinical Decision Support ◽  
Older Patients ◽  
Clinical Decision ◽  
Inappropriate Drug ◽  
Mixed Methods Evaluation ◽  
Inappropriate Drug Use

From Adverse Drug Event Detection to Prevention

2014 ◽  
Vol 53 (06) ◽  
pp. 482-492 ◽  
Author(s):  
P. McNair ◽  
V. Kilintzis ◽  
K. Skovhus Andersen ◽  
J. Niès ◽  
J.-C. Sarfati ◽  
...  
Keyword(s):  
Patient Safety ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Adverse Drug Event ◽  
Support Services ◽  
Medication Safety ◽  
Point Of Care ◽  
Clinical Decision ◽  
Substantial Contribution ◽  
Drug Event

Summary Background: Errors related to medication seriously affect patient safety and the quality of healthcare. It has been widely argued that various types of such errors may be prevented by introducing Clinical Decision Support Systems (CDSSs) at the point of care. Objectives: Although significant research has been conducted in the field, still medication safety is a crucial issue, while few research outcomes are mature enough to be considered for use in actual clinical settings. In this paper, we present a clinical decision support framework targeting medication safety with major focus on adverse drug event (ADE) prevention. Methods: The novelty of the framework lies in its design that approaches the problem holistically, i.e., starting from knowledge discovery to provide reliable numbers about ADEs per hospital or medical unit to describe their consequences and probable causes, and next employing the acquired knowledge for decision support services development and deployment. Major design features of the frame-work’s services are: a) their adaptation to the context of care (i.e. patient characteristics, place of care, and significance of ADEs), and b) their straightforward integration in the healthcare information technologies (IT) infrastructure thanks to the adoption of a service-oriented architecture (SOA) and relevant standards. Results: Our results illustrate the successful interoperability of the framework with two commercially available IT products, i.e., a Computerized Physician Order Entry (CPOE) and an Electronic Health Record (EHR) system, respectively, along with a Web prototype that is independent of existing health-care IT products. The conducted clinical validation with domain experts and test cases illustrates that the impact of the framework is expected to be major, with respect to patient safety, and towards introducing the CDSS functionality in practical use. Conclusions: This study illustrates an important potential for the applicability of the presented framework in delivering contextualized decision support services at the point of care and for making a substantial contribution towards ADE prevention. None-theless, further research is required in order to quantitatively and thoroughly assess its impact in medication safety.

scholarly journals Effect of Interventions With a Clinical Decision Support System for Hospitalized Older Patients: Systematic Review Mapping Implementation and Design Factors

10.2196/28023 ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. e28023
Author(s):  
Birgit A Damoiseaux-Volman ◽  
Nathalie van der Velde ◽  
Sil G Ruige ◽  
Johannes A Romijn ◽  
Ameen Abu-Hanna ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Older Patients ◽  
Clinical Decision ◽  
Risk Of Bias ◽  
Hospitalized Patients ◽  
Effective Interventions ◽  
Design Factors ◽  
Implementation Factors

Background Clinical decision support systems (CDSSs) form an implementation strategy that can facilitate and support health care professionals in the care of older hospitalized patients. Objective Our study aims to systematically review the effects of CDSS interventions in older hospitalized patients. As a secondary aim, we aim to summarize the implementation and design factors described in effective and ineffective interventions and identify gaps in the current literature. Methods We conducted a systematic review with a search strategy combining the categories older patients, geriatric topic, hospital, CDSS, and intervention in the databases MEDLINE, Embase, and SCOPUS. We included controlled studies, extracted data of all reported outcomes, and potentially beneficial design and implementation factors. We structured these factors using the Grol and Wensing Implementation of Change model, the GUIDES (Guideline Implementation with Decision Support) checklist, and the two-stream model. The risk of bias of the included studies was assessed using the Cochrane Collaboration’s Effective Practice and Organisation of Care risk of bias approach. Results Our systematic review included 18 interventions, of which 13 (72%) were effective in improving care. Among these interventions, 8 (6 effective) focused on medication review, 8 (6 effective) on delirium, 7 (4 effective) on falls, 5 (4 effective) on functional decline, 4 (3 effective) on discharge or aftercare, and 2 (0 effective) on pressure ulcers. In 77% (10/13) effective interventions, the effect was based on process-related outcomes, in 15% (2/13) interventions on both process- and patient-related outcomes, and in 8% (1/13) interventions on patient-related outcomes. The following implementation and design factors were potentially associated with effectiveness: a priori problem or performance analyses (described in 9/13, 69% effective vs 0/5, 0% ineffective interventions), multifaceted interventions (8/13, 62% vs 1/5, 20%), and consideration of the workflow (9/13, 69% vs 1/5, 20%). Conclusions CDSS interventions can improve the hospital care of older patients, mostly on process-related outcomes. We identified 2 implementation factors and 1 design factor that were reported more frequently in articles on effective interventions. More studies with strong designs are needed to measure the effect of CDSS on relevant patient-related outcomes, investigate personalized (data-driven) interventions, and quantify the impact of implementation and design factors on CDSS effectiveness. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews): CRD42019124470; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124470.

Priority Setting in Improving Hospital Care for Older Patients Using Clinical Decision Support

2019 ◽  
Vol 20 (8) ◽  
pp. 1045-1047
Author(s):  
Birgit A. Damoiseaux-Volman ◽  
Stephanie Medlock ◽  
Kim J. Ploegmakers ◽  
Fatma Karapinar-Çarkit ◽  
C.T. Paul Krediet ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Priority Setting ◽  
Older Patients ◽  
Hospital Care ◽  
Clinical Decision

Clinical Decision Support Intervention and Time to Imaging in Older Patients with Traumatic Brain Injury

2020 ◽  
Vol 231 (3) ◽  
pp. 361-367.e2
Author(s):  
Arthur S. Nguyen ◽  
Simon Yang ◽  
Brian V. Thielen ◽  
Kristina Techar ◽  
Regina M. Lorenzo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Support ◽  
Brain Injury ◽  
Clinical Decision Support ◽  
Older Patients ◽  
Clinical Decision ◽  
Support Intervention ◽  
Decision Support Intervention

scholarly journals The implementation, use and sustainability of a clinical decision support system for medication optimisation in primary care: A qualitative evaluation

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250946
Author(s):  
Mark Jeffries ◽  
Nde-Eshimuni Salema ◽  
Libby Laing ◽  
Azwa Shamsuddin ◽  
Aziz Sheikh ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Medication Safety ◽  
Qualitative Evaluation ◽  
Clinical Decision ◽  
Population Characteristics ◽  
Successful Implementation ◽  
General Practices

Background The quality and safety of prescribing in general practice is important, Clinical decision support (CDS) systems can be used which present alerts to health professionals when prescribing in order to identify patients at risk of potentially hazardous prescribing. It is known that such computerised alerts may improve the safety of prescribing in hospitals but their implementation and sustainable use in general practice is less well understood. We aimed to understand the factors that influenced the successful implementation and sustained use in primary care of a CDS system. Methods Participants were purposively recruited from Clinical Commissioning Groups (CCGs) and general practices in the North West and East Midlands regions of England and from the CDS developers. We conducted face-to-face and telephone-based semi-structured qualitative interviews with staff stakeholders. A selection of participants was interviewed longitudinally to explore the further sustainability 1–2 years after implementation of the CDS system. The analysis, informed by Normalisation Process Theory (NPT), was thematic, iterative and conducted alongside data collection. Results Thirty-nine interviews were conducted either individually or in groups, with 33 stakeholders, including 11 follow-up interviews. Eight themes were interpreted in alignment with the four NPT constructs: Coherence (The purpose of the CDS: Enhancing medication safety and improving cost effectiveness; Relationship of users to the technology; Engagement and communication between different stakeholders); Cognitive Participation (Management of the profile of alerts); Collective Action (Prescribing in general practice, patient and population characteristics and engagement with patients; Knowledge);and Reflexive Monitoring (Sustaining the use of the CDS through maintenance and customisation; Learning and behaviour change. Participants saw that the CDS could have a role in enhancing medication safety and in the quality of care. Engagement through communication and support for local primary care providers and management leaders was considered important for successful implementation. Management of prescribing alert profiles for general practices was a dynamic process evolving over time. At regional management levels, work was required to adapt, and modify the system to optimise its use in practice and fulfil local priorities. Contextual factors, including patient and population characteristics, could impact upon the decision-making processes of prescribers influencing the response to alerts. The CDS could operate as a knowledge base allowing prescribers access to evidence-based information that they otherwise would not have. Conclusions This qualitative evaluation utilised NPT to understand the implementation, use and sustainability of a widely deployed CDS system offering prescribing alerts in general practice. The system was understood as having a role in medication safety in providing relevant patient specific information to prescribers in a timely manner. Engagement between stakeholders was considered important for the intervention in ensuring prescribers continued to utilise its functionality. Sustained implementation might be enhanced by careful profile management of the suite of alerts in the system. Our findings suggest that the use and sustainability of the CDS was related to prescribers’ perceptions of the relevance of alerts. Shared understanding of the purpose of the CDS between CCGS and general practices particularly in balancing cost saving and safety messages could be beneficial.

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