The usability aspects of medication-related decision support systems in the inpatient setting: A systematic review.

Effort has been made to study the effect of medication-related clinical decision support systems in the inpatient setting; however, there is not much known about the usability of these systems. The goal of this study is to systematically review studies that focused on the usability aspects such as effectiveness, efficiency, and satisfaction of these systems. We systematically searched relevant articles in Scopus, Embase, and PubMed from 1 January 2000 to 1 January 2016, and found 22 articles. Based on Van Welie's usability model, we categorized usability aspects in terms of usage indicators and means. Our results showed that evidence was mainly found for effectiveness and efficiency. They showed positive results in the usage indicators errors and safety and performance speed. The means warnings and adaptability also had mostly positive results. To date, the effects satisfaction of clinical decision support system remains understudied. Aspects such as memorability, learnability, and consistency require more attention.

Usability aspects of medication-related decision support systems in the outpatient setting: A systematic literature review.

In this study, we evaluated the usability aspects of medication-related clinical decision support systems in the outpatient setting. Articles published between 2000 and 2016 in Scopus, PubMed and EMBASE were searched and classified into three usability aspects: Effectiveness, Efficiency and Satisfaction. Using Van Welie et al.'s usability model, we categorized usability aspects in terms of usage indicators and means. Out of the 1999 articles, 24 articles met the selection criteria of which the main focus was on reducing inappropriate medication, prescription rate and prescription errors. Evidence could mainly be found for Effectiveness and showed high rates of positive results in reducing medication errors. To date, the effects of Efficiency and Satisfaction of clinical decision support systems regarding medication prescription remain understudied. Usability aspects such as memorability, learnability, adaptability, shortcuts and consistency require more attention. Studies are needed for better insight into the user model and to design a knowledge/task model for clinical decision support systems regarding medication prescription.

Frequency and nature of drug-drug interactions in the intensive care unit.

PURPOSE: Drug-drug interactions (DDIs) may compromise patient safety. However, there are no good estimates of their frequency or understanding of their nature in the intensive care unit (ICU). The objective of this study was to determine the frequency and nature of potential DDIs (pDDIs) in the ICU when assessed in light of documented and perceived clinical relevance. METHODS: We developed a computerized algorithm to identify pDDI occurrence in ICU admissions with medication administration, on the basis of the Dutch national drug database. A panel of nine local pharmacists and intensivists completed questionnaires to classify the perceived relevance of the identified pDDI types for the ICU. A focus group discussed the conflicting classifications of relevance to reach consensus. For the pDDI types classified as relevant, we calculated their number and frequency per admission days. RESULTS: Out of 9644 admissions, 3892 had at least one pDDI. The pDDIs corresponded to 85 types, 36 of which were deemed relevant on the basis of the survey and focus group. These 36 types corresponded to 16,122 pDDIs (rate: 33.6 per 100 admission days) and 1084 unique admissions. PDDIs occurred in 11% of admissions to the general ICU, after limiting analysis to severe and relevant DDI types. The most frequently encountered drug classes were antithrombotic agents and antibacterials for systemic use. CONCLUSIONS: There are many potential DDIs with high perceived relevance in the ICU that appear to require attention and follow-up. Computerized decision support may help reduce the number of pDDIs but needs to be tailored to the environment in which it operates.

Relevance of drug-drug interaction in the ICU - perceptions of intensivists and pharmacists.

Relevancy of potential drug-drug interactions (pDDIs) is crucial in alerting system design. However, the way this relevancy is perceived is not well understood. The main objective of this study was to gauge and identify differences in perceptions of intensivists and pharmacists about pDDI relevancy in the ICU. Interactions were defined according to the national medication database using a computerized algorithm. Intensivists and pharmacists filled in a questionnaire to score their perceptions on relevancy of encountered pDDIs types. We conducted a focus group session to discuss pDDIs receiving markedly different relevancy scores. The questionnaire addressed 53 pDDI types. Pharmacists rated 29 pDDI types (54.7%) in the broad category "relevant" versus 16 (30.2%) for intensivists (p-value<0.001). The pharmacists and intensivists gave the same scores for 23 pDDI types (12 as relevant, and 11 as not relevant), and scored 30 types differently. The focus group discussion resulted in a total of 36 relevant and 17 not relevant types. Compared to the pharmacists in this panel, the intensivists were less inclined to consider a pDDI type as relevant. It is important to tailor medication databases with information about evidence and severity of pDDIs to the environment in which they are used.