Using a clinical decision support system to determine the quality of antimicrobial dosing in intensive care patients with renal insufficiency

Helmons, PJ; Grouls, RJ; Roos, Arnout N.; Bindels, Ajgh; Wessels-Basten, Sjw; Ackerman, E. W.; Korsten, Hhm Erik

doi:10.1136/qshc.2007.025700

Cited by 38 publications

(18 citation statements)

References 25 publications

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“…Dutch clinical pharmacy focuses on individual patient treatment—for instance, by developing automated CDS and rules tailored to specific patients 19 20…”

Section: Introductionmentioning

confidence: 99%

Clinical pharmacy interventions in paediatric electronic prescriptions

Maat

Bollen

et al. 2012

Archives of Disease in Childhood

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Paediatric prescribing errors occur frequently and are not completely prevented by electronic prescribing systems. This study provides information for improvements in electronic prescribing for paediatric patients. Incorporating tailored solutions, such as minimised free-text entry, certain obligatory fields and integrated dose checking and indications, can improve the quality and efficiency of electronic prescribing in paediatrics.

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“…Dutch clinical pharmacy focuses on individual patient treatment—for instance, by developing automated CDS and rules tailored to specific patients 19 20…”

Section: Introductionmentioning

confidence: 99%

Clinical pharmacy interventions in paediatric electronic prescriptions

Maat

Bollen

et al. 2012

Archives of Disease in Childhood

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“…The approach included an extensive review of the guidelines throughout the development. It used the network structure for which extra time was needed, but it enabled broader support of the guidelines and may enhance future guideline implementation [24,25]. …”

Section: Discussionmentioning

confidence: 99%

A patient-centered network approach to multidisciplinary-guideline development: a process evaluation

et al. 2014

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BackgroundGuideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals’ experiences, and time invested.MethodsThe network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. The guideline development addressed patient-centered, organizational, and medical-technical key questions derived from interviews with patients and professionals. These questions were elaborated and distributed among the groups. We evaluated the project performance, participants’ perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key figures, and a written questionnaire survey among 35 participants.ResultsWithin 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. The multidisciplinary guideline included recommendations for the main medical-technical matters and for organizational and patient-centered issues in clinical care pathways. The project was carried out as planned except for minor modifications and three extra consensus meetings. The participants were enthusiastic about the approach, the respect for autonomy, the project coordinator’s role, and patient involvement. Suggestions for improvement included timely communication about guideline formats, the timeline, participants’ responsibilities, and employing a librarian and more support staff. The 35 participants spent 4497 hours in total on this project.ConclusionsThe novel patient-centered network approach is feasible for simultaneously and collaboratively developing a harmonized set of multidisciplinary and monodisciplinary guidelines around clinical care pathways for patients with fertility problems. Further research is needed to compare the efficacy of this approach with more traditional approaches.

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“…However, previous studies have shown that providers override 50–80% of alerts generated by renal decision support systems. [7–9] These high override rates imply that either too many alerts are being delivered or providers may be overriding clinically important suggestions. Some providers may be especially likely to override alerts, and thus, there is scope for improvement.…”

Section: Introductionmentioning

confidence: 99%

Understanding physicians’ behavior toward alerts about nephrotoxic medications in outpatients: a cross-sectional analysis

et al. 2014

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BackgroundAlthough most outpatients are relatively healthy, many have chronic renal insufficiency, and high override rates for suggestions on renal dosing have been observed. To better understand the override of renal dosing alerts in an outpatient setting, we conducted a study to evaluate which patients were more frequently prescribed contraindicated medications, to assess providers’ responses to suggestions, and to examine the drugs involved and the reasons for overrides.MethodsWe obtained data on renal alert overrides and the coded reasons for overrides cited by providers at the time of prescription from outpatient clinics and ambulatory hospital-based practices at a large academic health care center over a period of 3 years, from January 2009 to December 2011. For detailed chart review, a group of 6 trained clinicians developed the appropriateness criteria with excellent inter-rater reliability (κ = 0.93). We stratified providers by override frequency and then drew samples from the high- and low-frequency groups. We measured the rate of total overrides, rate of appropriate overrides, medications overridden, and the reason(s) for override.ResultsA total of 4120 renal alerts were triggered by 584 prescribers in the study period, among which 78.2% (3,221) were overridden. Almost half of the alerts were triggered by 40 providers and one-third was triggered by high-frequency overriders. The appropriateness rates were fairly similar, at 28.4% and 31.6% for high- and low-frequency overriders, respectively. Metformin, glyburide, hydrochlorothiazide, and nitrofurantoin were the most common drugs overridden. Physicians’ appropriateness rates were higher than the rates for nurse practitioners (32.9% vs. 22.1%). Physicians with low frequency override rates had higher levels of appropriateness for metformin than the high frequency overriders (P = 0.005).ConclusionA small number of providers accounted for a large fraction of overrides, as was the case with a small number of drugs. These data suggest that a focused intervention targeting primarily these providers and medications has the potential to improve medication safety.

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Using a clinical decision support system to determine the quality of antimicrobial dosing in intensive care patients with renal insufficiency

Abstract: Despite intensive monitoring of patients in the ICU, dosage adjustment of antimicrobials is often omitted. Implementing this clinical rule has the potential to contribute to a significant improvement in medication safety and is expected to generate substantial savings.

Cited by 38 publications

References 25 publications

Clinical pharmacy interventions in paediatric electronic prescriptions

Clinical pharmacy interventions in paediatric electronic prescriptions

A patient-centered network approach to multidisciplinary-guideline development: a process evaluation

Understanding physicians’ behavior toward alerts about nephrotoxic medications in outpatients: a cross-sectional analysis

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