Improving medication-related clinical decision support

Why it’s time to get active about clinical decision support

Active, medication-related, clinical decision support (CDS) is surfacing as a critical enabler for greater patient safety, with a new report stressing standardisation and integration of patient-specific parameters are central to realising a new evidence-based approach.

A new actionable evidence-based approach

A new study by the American Journal of Health System Pharmacy, Improving medication-related clinical decision support, found that in the effort to optimise patient safety, CDS needs to move away from a ‘passive’ approach to a more ‘active’, evidence-based and actionable method.

“Medication-related CDS is still relatively immature in some organisations and has substantial room for improvement,” the report stated. “For example, decision support should consider more patient-specific factors, human factors principles should always be considered, and alert specificity must be improved in order to reduce alert fatigue.”

Importantly, the study found:

• Human factors principles and user-centred design should be considered when designing and developing medication-related clinical decision support (CDS).
• In order to reduce alert fatigue, the sensitivity and specificity of alerts must be improved by including more patient-specific information into decision- making algorithms.
• Further research is needed to understand providers’ responses to CDS and adapt these systems according to practice changes.

Critical patient safety model

According to the report, more actionable, evidence-based CDS is particularly critical when it comes to cross-sensitivity checks and drug allergy checks.

“The ability to perform appropriate cross-sensitivity checks is key to producing appropriate drug allergy checks,” the report added. “Drug dosage alerts should be individualised and deliver practical recommendations. How the system is configured to identify certain drug duplication is important to prevent possible patient toxicity. Accurate knowledge databases are needed to produce relevant drug formulary alerts and encourage formulary adherence.”

Key recommendations

In order to drive a more actionable CDS healthcare model, the report recommended CDS systems incorporate more patient-specific information into decision-making algorithms and employ human factors design principles.

The report also called for healthcare teams to be more accountable for improving intrasystem interoperability, and ensure more regular updates of CDS systems to optimise accurate information sharing. After system implementation, healthcare teams should regularly audit system usage and users’ experience with the system, the report stressed.

“Standardisation, integration of patient-specific parameters, and consideration of human factors design principles are central to realising the potential benefits of medication-related CDS,” the report concluded.

In practice

What is particularly exciting is that MedicalDirector’s Medicines Information Database is closely aligned with the report’s key recommendations to drive more patient-centric, accurate and medication-related CDS.  Specifically, MedicalDirector’s Medicines Information Database is the core behind all relevant applications such as AusDI, Clinical and Helix platforms, and our innovation roadmap strongly supports the report’s recommendation to offer more standardised and integrated patient-specific parameters.

Moving forward, a combined expertise in both publishing medicines information and developing clinical applications puts MedicalDirector in the ideal position to continue to innovate in line with the reports conclusions, while keeping semantic interoperability and security front on mind. This is all enabled by a maturation of clinical ontologies such as SNOMED CT and AMT.