Validity of a clinical decision rule based alert system for drug dose
  adjustment in patients with renal failure intended to improve pharmacists'
  analysis of medication orders in hospitals
  Objective: The main objective of this study was to assess the diagnostic
performances of an alert system integrated into the CPOE/EMR system for renally
cleared drug dosing control. The generated alerts were compared with the daily
routine practice of pharmacists as part of the analysis of medication orders.
Materials and Methods: The pharmacists performed their analysis of medication
orders as usual and were not aware of the alert system interventions that were
not displayed for the purpose of the study neither to the physician nor to the
pharmacist but kept with associate recommendations in a log file. A senior
pharmacist analyzed the results of medication order analysis with and without
the alert system. The unit of analysis was the drug prescription line. The
primary study endpoints were the detection of drug-dose prescription errors and
inter-rater reliability between the alert system and the pharmacists in the
detection of drug dose error. Results: The alert system fired alerts in 8.41%
(421/5006) of cases: 5.65% (283/5006) exceeds max daily dose alerts and 2.76%
(138/5006) under dose alerts. The alert system and the pharmacists showed a
relatively poor concordance: 0.106 (CI 95% [0.068, 0.144]). According to the
senior pharmacist review, the alert system fired more appropriate alerts than
pharmacists, and made fewer errors than pharmacists in analyzing drug dose
prescriptions: 143 for the alert system and 261 for the pharmacists. Unlike the
alert system, most diagnostic errors made by the pharmacists were false
negatives. The pharmacists were not able to analyze a significant number (2097;
25.42%) of drug prescription lines because understaffing. Conclusion: This
study strongly suggests that an alert system would be complementary to the
pharmacists activity and contribute to drug prescription safety.
