Objective

Evaluation of the effect of six optimization strategies in a clinical decision support system (CDSS) for drug-drug interaction (DDI) screening on alert burden and alert acceptance and description of clinical pharmacist intervention acceptance.

Methods

Optimizations in the new CDSS were the customization of the knowledge base (with addition of 67 extra DDIs and changes in severity classification), a new alert design, required override reasons for the most serious alerts, the creation of DDI-specific screening intervals, patient-specific alerting, and a real-time follow-up system of all alerts by clinical pharmacists with interventions by telephone was introduced. The alert acceptance was evaluated both at the prescription level (i.e. prescription acceptance, was the DDI prescribed?) and at the administration level (i.e. administration acceptance, did the DDI actually take place?). Finally, the new follow-up system was evaluated by assessing the acceptance of clinical pharmacist’s interventions.

Results

In the pre-intervention period, 1087 alerts (92.0 % level 1 alerts) were triggered, accounting for 19 different DDIs. In the post-intervention period, 2630 alerts (38.4 % level 1 alerts) were triggered, representing 86 different DDIs. The relative risk forprescription acceptance in the post-intervention period compared to the pre-intervention period was 4.02 (95 % confidence interval (CI) 3.17–5.10; 25.5 % versus 6.3 %). The relative risk for administration acceptance was 1.16 (95 % CI 1.08–1.25; 54.4 % versus 46.7 %). Finally, 86.9 % of the clinical pharmacist interventions were accepted.

Conclusion

Six concurrently implemented CDSS optimization strategies resulted in a high alert acceptance and clinical pharmacist intervention acceptance. Administration acceptance was remarkably higher than prescription acceptance.

中文翻译：

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用于药物相互作用筛选的优化的情境感知临床决策支持系统的评估

目的

评估临床决策支持系统（CDSS）中六种优化策略对警戒负担和警戒接受筛查的药物相互作用（DDI）的效果，以及对临床药剂师干预接受的描述。

方法

新CDSS的优化包括知识库的自定义（添加了67个额外的DDI和严重性分类的更改），新的警报设计，最严重警报所需的替代原因，创建了DDI特定的筛查间隔，患者引入了特定的警报，并引入了临床药剂师通过电话进行干预的所有警报的实时跟踪系统。在处方级别（即处方验收，是否规定了DDI？）和管理水平（即行政验收，DDI实际发生了吗？）进行了警报接受的评估。最后，通过评估临床药剂师干预措施的接受程度来评估新的随访系统。

结果

在干预前的时期内，触发了1087次警报（92.0％的1级警报），占19种不同的DDI。在干预后期间，触发了2630个警报（占18.4级警报的38.4％），代表86个不同的DDI。与干预前相比，干预后期间接受处方的相对风险为4.02（95％置信区间（CI）为3.17-5.10； 25.5％与6.3％）。接受行政管理的相对风险为1.16（95％CI 1.08–1.25； 54.4％对46.7％）。最终，接受了86.9％的临床药剂师干预。

结论

六个同时执行的CDSS优化策略导致高度警惕的接受度和临床药剂师干预的接受度。行政接受程度明显高于处方接受程度。