Background and importance Clinical decision support systems (CDSSs) are frequently adopted in hospitals to increase prescription accuracy in patients with renal impairment, but the alerts from CDSSs are usually overridden in clinical practice. Therefore, an intensified CDSS with more detailed information should be developed and its effectiveness with regard to prescribing errors determined.
Aim and objectives To evaluate the effectiveness of an intensified CDSS with regard to prescribing errors for inappropriate drugs in cases of renal dysfunction.
Material and methods We conducted a pre- and post-intervention study in an inpatient setting in the largest medical centre in Taiwan in 2019. Previously, the CDSS only reminded clinicians to adjust drugs according to the patient’s renal function. After May 2019, we initiated an intensified CDSS directly providing clinicians with the precise drug dosage or alternative drug recommendations for patients with renal impairment. The study outcome was the rate of prescribing errors, as identified by pharmacists after prescribing by clinicians. We used interrupted time series analysis to estimate the trend in prescribing error rate before (January 2019 to May 2019) and after (June 2019 to December 2019) implementing the intensified CDSS. As a control, we conducted similar analyses in another hospital with the same healthcare systems but without an intensified CDSS. We hypothesised there would be a reduction in the rate of prescribing errors for inappropriate drugs in cases of renal dysfunction after the intensification of CDSS in the study hospital, compared with the control hospital.
Results The mean prescribing error rates due to inappropriate drugs in patients with renal dysfunction were 1.70 and 1.59 per 1000 inpatient beds before and after the introduction of the intensified CDSS, respectively, which did not constitute a significant change between the pre- and post- intervention (β=0.01; 95% CI −0.32 to 0.35). However, we observed a non-significantly increased prescribing error rate between the study hospital and the control hospital (β=0.04; 95% CI −0.51 to 0.59) after the introduction of the intensified CDSS.
Conclusion and relevance The deployment of an intensified CDSS providing detailed information on how to prescribe drugs for patients with renal impairment may inhibit the increase in prescribing error rate due to inappropriate drugs in patients with renal dysfunction.
Conflict of interest No conflict of interest