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Russmann S, Martinelli F, Jakobs F, Pannu M, Niedrig DF, Burden AM, Kleber M, Béchir M. Identification of Medication Prescription Errors and Factors of Clinical Relevance in 314 Hospitalized Patients for Improved Multidimensional Clinical Decision Support Algorithms. J Clin Med 2023; 12:4920. [PMID: 37568322 PMCID: PMC10419486 DOI: 10.3390/jcm12154920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Potential medication errors and related adverse drug events (ADE) pose major challenges in clinical medicine. Clinical decision support systems (CDSSs) help identify preventable prescription errors leading to ADEs but are typically characterized by high sensitivity and low specificity, resulting in poor acceptance and alert-overriding. With this cross-sectional study we aimed to analyze CDSS performance, and to identify factors that may increase CDSS specificity. Clinical pharmacology services evaluated current pharmacotherapy of 314 patients during hospitalization across three units of two Swiss tertiary care hospitals. We used two CDSSs (pharmaVISTA and MediQ), primarily for the evaluation of drug-drug interactions (DDI). Additionally, we evaluated potential drug-disease, drug-age, drug-food, and drug-gene interactions. Recommendations for change of therapy were forwarded without delay to treating physicians. Among 314 patients, automated analyses by both CDSSs produced an average of 15.5 alerts per patient. In contrast, additional expert evaluation resulted in only 0.8 recommendations per patient to change pharmacotherapy. For clinical pharmacology experts, co-factors such as comorbidities and laboratory results were decisive for the classification of CDSS alerts as clinically relevant in individual patients in about 70% of all decisions. Such co-factors should therefore be used for the development of multidimensional CDSS alert algorithms with improved specificity. In combination with local expert services, this poses a promising approach to improve drug safety in clinical practice.
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Affiliation(s)
- Stefan Russmann
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
- Drugsafety.ch, Seestrasse 221, 8703 Küsnacht, Switzerland;
- Department of Internal Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
- Center for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland
| | - Fabiana Martinelli
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Franziska Jakobs
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Manjinder Pannu
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
| | - David F. Niedrig
- Drugsafety.ch, Seestrasse 221, 8703 Küsnacht, Switzerland;
- Hospital Pharmacy, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland
| | - Andrea Michelle Burden
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Martina Kleber
- Department of Internal Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Markus Béchir
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
- Center for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland
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Hahn M, Roll SC. The role of phenoconversion in the pharmacogenetics of psychiatric medication. Pharmacogenomics 2023; 24:485-487. [PMID: 37427432 DOI: 10.2217/pgs-2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Affiliation(s)
- Martina Hahn
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, 65929, Germany
- Department of Psychiatry, Psychosomatics & Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt, 60528, Germany
| | - Sibylle C Roll
- Department of Psychiatry, Psychosomatics & Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt, 60528, Germany
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