Pharmacists' awareness of clinical decision support in pharmacy information systems: an exploratory evaluation

Clinical decision support (CDS), such as drug-drug interaction (DDI) and drug-allergy checking, has been used in pharmacy information systems for several decades; however, there has been limited research on CDS use by practicing pharmacists.

The purpose of this study was to document pharmacists' awareness of DDI and other medication-related CDS features available within pharmacy information systems.

Researchers conducted on-site interviews with pharmacists throughout the state of Arizona from December 2008 to November 2009 regarding their pharmacy information systems features. Pharmacists were asked to provide information about DDI and other medication-related decision support features of the pharmacy software at their practice site. Descriptive statistics were used to summarize interview responses.

Sixty-one pharmacists from a variety of practice settings completed the interview. All respondents indicated that their pharmacy system provided drug-allergy and DDI alerts. Approximately 60% of the pharmacists reported that their DDI decision support systems included recommendations for managing drug interactions. Two-thirds of respondents reported that their pharmacy's computer system permitted the addition of medications from other pharmacies and/or over-the-counter products to a patient's profile. Approximately 40% of the pharmacists reported that some drugs entered into the pharmacy computer system were not included in (or linked to) the electronic DDI checking. Most pharmacists indicated the presence of other medication-related decision support features, such as drug-disease (78%), drug-age precautions (67%), and inappropriate dosage alerts (79%). However, fewer pharmacists reported more advanced functionality, such as laboratory recommendations (34%) and pediatric dosing (39%).

Overall, pharmacists' awareness regarding the many decision support functionalities of their systems was limited. Based on the study findings, it appears that there are a number of limitations associated with currently available pharmacy decision support software. Further research is needed to formally evaluate pharmacist knowledge of pharmacy decision support software functionality. More formal training about software capabilities coupled with the addition of more advanced decision support features has the potential to improve pharmacists' use of these systems to make better clinical decisions and avoid preventable errors.