Summary
Objectives: Because information of contraindication and careful indication of medication is vast,
there have been numerous cases of prescribing medication inappropriately. Our goal
is to have a clinical decision support system (CDSS) combined with a computerized
physician order entry (CPOE) to aid physicians in prescribing medication appropriately.
In this study we developed an alert system for evaluating renal function and checking
doses of medication according to the patient’s renal function. In addition, we developed
functions of extracting target problems from the raw data and verifying if contraindicated
medication has being prescribed.
Methods: This system scrutinizes data handled in the CPOE system. It picks up the data needed
to ascertain problems and the data of medication entered from the order entry system.
First we made an alert system for renal dysfunction. Creatinine clearance (Ccr) of
a patient was calculated by the estimate equation of Cockcroft and Gault. If a patient
data fulfills the condition of impaired renal function, the alert message is sent
to the database. The alert system also checks the dosage of each medication according
to a patient’s renal function. When the dosage is over-prescribed, an alert is sent.
Next, we made an alert system targeting contraindication for liver diseases, renal
diseases and diabetes mellitus. The criteria of these problems were set in the knowledge
base. If a patient’s data meets the criteria, that fact is stored in the problem database.
The system also keeps a prescription check master and checks whether the patient has
a problem which is a contraindication of the prescribed medication. If a problem exists,
an alert is sent to the alert message database. The alert-presenting module is a web
system. After accepting patients’ ID indicated by a user, the system searches the
alerts concerning the patients from the database and constructs pages presenting the
alert message.
Results: We compared the period during which the contraindicated medication was prescribed
before and after the alert system was put into operation. Of the patients with renal
dysfunction who were prescribed the contraindicated medication, 24% had their medication
discontinued before the alert system was put into operation. In contrast, the rate
significantly increased to 54% after the alert system began to function.
Conclusion: We developed an alert system for inappropriate prescriptions for each patient’s clinical
condition. The alerts generated by this system were effective for discontinuing contraindicated
medication.
Keywords
Clinical decision support systems - contraindications - renal insufficiency - liver
diseases - diabetes mellitus
