Background and importance The hospital is planning to implement a closed-loop medication system, including dose-dispensed medication, which legally requires pharmaceutical validation. An advanced system for pharmaceutical validation, built on clinical rules based on real-time data on patients’ medication, laboratory data and diagnosis, is planned to be developed and implemented at the hospital. Pharmacists will be the first recipients of the alerts, only forwarding relevant alerts to the physician. The research project is called System Assisted Pharmaceutical Validation (SAPVAL). A challenge in developing clinical rules is to develop well-defined clinical rules that do not miss relevant risks or result in alert fatigue.
Aim and objectives The aim of the study was to determine a set of clinical rules and apply the rules to inpatient data to determine the prevalence and clinical significance of the generated alerts, as an element for a future system for pharmaceutical validation of inpatients’ prescriptions at the hospital.
Material and methods Through a literature search and consultations with local experts, a set of clinical rules was determined. A retrospective cross-sectional study was performed to validate the clinical rules on a study population of 500 patients aged 65 years and older. The clinical rules were applied on patient data from the electronic health records the day after admission to the hospital, to determine the prevalence of risk prescriptions generated by the clinical rules. It was investigated whether the risks remained after 2 days. From the total generated alerts, 10% were randomly selected and assessed for clinical relevance by an experienced clinician.
Results A number of 62 clinical rules were defined and applied. Of these, 40 rules generated one or more alerts. The clinical rules generated 893 alerts in 338 (68%) out of 500 patients, and 84% of alerts remained 2 days after the patient was admitted to the hospital or at discharge. From the randomly selected alerts 24% were deemed clinically relevant.
Conclusion and relevance In summary, the clinical rules generated a large number of alerts for risk prescriptions in a majority of hospital inpatients aged over 65 years. The risk prescriptions were very likely to remain after 2 days and a quarter of them were clinically relevant.
Conflict of interest No conflict of interest
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