Logotyp: till Uppsala universitets webbplats

Background: Uppsala University Hospital is planning to implement an advanced clinical decision support system based on clinical rules to screen for inappropriate prescriptions, where clinical pharmacists will be the first recipients of alerts. The database Janusmed Njurfunktion provides evidence-based recommendations for dose-adjustment according to renal function. To our knowledge, utilization in this area has previously not been explored.

Aim: The aim of this study is to validate a general selection of clinical rules developed in previous degree projects and new rules related to dose-adjusting in patients with renal impairment based on Janusmed Njurfunktion. In addition to this, the study aims to evaluate the management of alerts generated by these clinical rules, when forwarded to clinical pharmacists.

Methods: A prospective cross-sectional study was performed at Uppsala University Hospital’s two internal medicine wards during spring 2022. It involved manual application of 57 clinical rules by extracting data from the electronic health record and subsequently the alerts were assessed by clinical pharmacists.

Results: During four occasions of data-extraction, 464 alerts were generated in a sample of 134 patients, where 118 alerts were considered a risk prescription. Amongst all alerts, 91 % were generated by Janusmed Njurfunktion. From the 371 forwarded alerts, 1.3 % were deemed clinically relevant.

Conclusion: A high number of alerts were generated with low clinical relevance, which indicate challenges in using Janusmed Njurfunktion to alert for inappropriate prescribing in patients with renal impairment. Some added value was seen with medication alerts, but the clinical rules will likely need further development to alert for relevant risk prescriptions without causing alert fatigue.