Effect of developed computerized clinical decision support system on medication use in patients with renal impairment.
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Abstract
Objective: To evaluate inappropriate drug use in patients with chronic kidney disease in inpatient department before and after the implementation of the computerized clinical decision support system (CCDSS). Method: Research design was a quasi-experiment. The CCDSS developed by the researchers could alert on drug uses in various channels including 1. through computer system by displaying a pop up window when the patient received a drug requiring attention, and by automatically displaying eGFR value. 2. through important documents, i.e. medication administration record (MAR), by showing the last 3 eGFR values and displaying statement "patients with chronic kidney disease at various stages", and printing eGFR value on the drug label. In addition, there was a supportive database system for printing physician consultation form through the UE form (universal form entry) in the HOSxP program and being able to check the status of consultation through the MAR. This study compared inappropriate drug use before and after implementation of the system for 3 months by retrieving the data from electronic medical records in HOSxP. Results: After using the CCDSS system, inappropriate drug use decreased significantly from 52.58 to 39.10%(P <0.001). Inappropriate drug use decreased in 4 PCTs (patient care team) from the total of 6 PCTs, namely, surgery, medicine, critical care and kidney disease.After the implementation of the CCDSS, the system alerted for 320 times. The pharmacists consulted physicians on 157 alerts. Physicians changed, did not change and stopped medical treatment in 32.48, 50.96 and 16.56 percent of consultation, respectively. There were 9 items of drug with change of order by physicians as a result of consultation by pharmacists leading to the reduction of inappropriate drug use including ceftazidime, meropenem, cefazolin, ciprofloxacin, co-trimoxazole, ertapenem, augmentin, colchicine and glibanclamide. Conclusion: The developed system is effective in reducing inappropriate use of drugs in patients with chronic kidney disease.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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