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Published on: June 11, 2012
Effectiveness of the Clinical Decision Support System Upgrade in the Automated Unit Dose Drug Dispensing System
Kui Zhao1, Jianglin Li1, Mianwei Chen1
1Department of Pharmacy, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 518020 Shenzhen, Guangdong, China.
Objective:
This study aims to evaluate the effectiveness of the clinical decision support system (CDSS) upgrade in the automated unit-dose drug dispensing system (AUDDS), which comprises both the pre-review CDSS software of the automated drug unit-dose dispensing machine (ADDM) and the pre-verify CDSS software of the medication detection machine (MDM). The ultimate goal of these coordinated enhancements is to improve the overall dispensing efficiency of the AUDDS.
Methods:
A multidisciplinary collaboration involving pharmacists and the AUDDS engineer was established to implement two upgrades: the rule-based pre-review CDSS software in ADDM and the pre-verify CDSS software in MDM. The upgraded CDSS software of ADDM was configured to automatically identify and intercept three categories of clinically inappropriate inpatient medication orders (IMOs) based on real-time patient data from the hospital information system: duplicate IMOs, IMOs of excessive doses, and non-splittable IMOs. Upon detection, the CDSS software in ADDM generates an alert to notify the managing pharmacist, who conducts a telephone consultation with the prescribing doctor for timely resolution. The pre-verify CDSS software in MDM was upgraded to improve image acquisition and recognition accuracy and reduce the error rate in automatically identifying mismatched unit-dose medication bags (UMBs).
Results:
Pre-post comparisons revealed improvements in both workload and efficiency metrics and safety metrics. After the upgrade, total order volume (TOV) and order volume per pharmacist (OVP) showed a 7.54% mean increase, and the monthly total number of pre-verified unit-dose medication bags (MTN) revealed a 31.84% mean increase. The monthly volume of duplicate IMOs (MVDI) displayed a 11.62% mean reduction, and the ratio of duplicate IMOs (RDI) displayed a 19.32% mean reduction. The monthly volume of IMOs with excessive doses (MVIE) revealed a 35.20% mean reduction, and the ratio of IMOs with excessive doses (RIE) displayed a 41.78% mean reduction. The monthly true-positive error rate (MTER) displayed a 16.29% mean reduction. However, the monthly false-positive error rate (MFER) was higher after the upgrade. Non-splittable IMOs were rare in the study, so they were excluded from the comparison.
Conclusion:
This study demonstrates that the upgrade was associated with improvement of the appropriateness of long-term IMOs and the dispensing efficiency of AUDDS, thereby enhancing medication safety in hospital pharmacies.
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