Logo: to the web site of Uppsala University

Background: A closed-loop medication system is planned to be implemented at Uppsala University Hospital. Thus, an advanced pharmaceutical validation system called System-Assisted Pharmaceutical VALidation (SAPVAL) is being developed, which aims to identify and manage risk prescriptions, hence reducing potential adverse drug events (ADEs). The system is based on clinical rules that generate an alert due to a "risk score”. As part of SAPVAL, this study focuses on alerts related to an increased risk of bleeding.

Aim: This study aims to investigate, gain an enhanced understanding, and determine the clinical significance of alerts generated by one of the clinical rules (rule 2- risk of bleeding) that was developed within SAPVAL.

Methods: A cross-sectional retrospective study where alerts 100 from randomly selected patients, with a previously identified risk of bleeding, were investigated in regard to the risk period for potential/true ADEs, undertaken mitigation measures and clinical significance. This was done by accessing the patients’ electronic health records.

Results: The risk period for potential ADEs was 29 days. In total, 35 ADEs were identified, with anemia as the most common symptom. Mitigation measures were undertaken for 55 patients, of which the most common were prescription of a proton pump inhibitor and blood transfusions. The clinical evaluation showed that 66% of the 103 included alerts were deemed clinically insignificant.

Conclusion: Most alerts were deemed clinically insignificant. This in turn, emphasizes the importance of a system like SAPVAL, where insignificant alerts are filtered away by pharmacists before reaching the physicians, thus reducing problems related to alert fatigue.