Clinical rules in hospital pharmacy practice to prevent adverse drug events

Abstract

Adverse drug events (ADEs) refer to any injury from the use of a drug. ADEs occur frequently in hospitalized patients and a substantial proportion are considered preventable. A method to prevent ADEs is computerized physician order entry (CPOE) combined with a clinical decision support system (CDSS). This thesis describes the development and validation of our CDSS with clinical rules, called Adverse Drug Event Alerting System (ADEAS). The development and validation of ADEAS was successful but time-consuming. Further, this thesis describes the investigations in which 1) the ability of ADEAS to identify patients at risk of ADEs are studied and 2) the ability in which these potential ADEs can be prevented by interventions by the hospital pharmacist are studied. The results of the clinical validity studies show that ADEAS is able to identify patients at risk of ADEs and that this method is a useful addition to the conventional medication surveillance. The clinical utility studies show that ADEAS can effectively be used in daily hospital pharmacy practice to identify patients at risk of potential ADEs and that ADEAS based interventions by the hospital pharmacist can reduce the number of preventable ADEs. For future use the rule effectiveness and positive predictive value of the clinical rules should be improved.