Background Adverse drug events related to anticoagulants are common and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) are widely viewed as crucial for reducing prescribing errors.
Purpose To make prescriptions safer and to promote good practise, by developing CDSSs focused on oral and injectable anticoagulants.
Materials and Methods A review was carried out of existing guidelines and practise in the units.
About ten meetings with clinicians (cardiologists, thrombosis specialists) and pharmacists from the Pharmacy and Therapeutics Committee (PTC) were required to write these CDSSs.
The CDSSs were presented and tested in the cardiology units. New discussions and improvements in the CDSSs were made with prescribers, nurses and pharmacists.
The final CDSSs were validated by the Pharmacy and Therapeutics Committee (PTC).
Results Nine CDSSs had already been validated by the PTC: Vitamin K Antagonist (VKA), heparin sodium, heparin calcium, Low Molecular Weight Heparins (LMWHs) in prophylactic and curative treatment of deep-vein thrombosis and pulmonary embolism, LMWHs for acute coronary syndrome ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, LMWHs for cardiac arrhythmia, and treatment of heparin-induced thrombocytopenia.
There are still regular meetings to develop CDSSs on new anticoagulants: dabigatran, rivaroxaban and apixaban.
Each CDSS provides:
Information on the choice of a therapeutic strategy based on the indication and the clinical context.
Usual doses and rates of administration.
A dose calculation based on weight (heparins).
Overrun alerts when the dose is exceeded.
Regular laboratory tests at the recommended frequency.
Protocols for dosage adjustments based on the biological values.
Administration modalities for the nurses.
Since the implementation of the CDSS on VKA, annual fluindione prescriptions have decreased by 17% and annual warfarin prescriptions have increased by 53% in accordance with the recommendation to prescribe warfarin as the first-line oral anticoagulant.
Conclusions Development of CDSSs referred to by the CPOE system takes a lot of time but is a good way of disseminating PTC guidelines to all prescribers, pharmacists and nurses. CDSSs can assist clinicians in the management of patients requiring anticoagulant treatment by improving compliance with care standards. These CDSSs are updated following changes in guidelines and clinical practise. Other CDSSs focused on high-alert medicines will be introduced when computerised prescribing is implemented for the entire hospital.
No conflict of interest.
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