Development of a computerised alert system, ADEAS, to identify patients at risk for an adverse drug event.

INTRODUCTION: Adverse drug events (ADEs) are frequent and pose an important risk for patients treated with drugs. Fortunately, a substantial part of ADEs is preventable, and computerised physician order entry with a sophisticated clinical decision support system may be used to reach this goal. OBJECTIVE: To develop a new automated system that could improve the quality of medication surveillance. The system should focus on detecting patients at risk for an ADE by combining data from the hospital information system and computerised physician order entry (drug prescription data, drug-drug interaction alerts, clinical chemical laboratory parameters, demographic features), using clinical rules. METHODS: The clinical rules were formulated in a multidisciplinary team, based on seven risk categories. The new system was composed in a guideline-based decision support framework consisting of both a guideline development module and a decision support module. A total of 121 clinical rules were built into the system. Validation of the system and a proof of principle test were performed. RESULTS: The adverse drug event alerting system (ADEAS) was developed and validated successfully. The proof of principle test showed that ADEAS has potential clinical usefulness. ADEAS generated alerts and detected additional potential risk situations, which were not generated by the conventional medication surveillance. CONCLUSION: We developed a pharmacy decision support system ADEAS that focuses on the detection of situations prone to lead to an ADE and might help clinicians to take timely corrective interventions and thereby can prevent patient harm.

[Hypersexuality during use of levodopa]. / Hyperseksualiteit tijdens gebruik van levodopa.

A 71-year-old single male who was being treated for Parkinson's disease with levodopa, had several episodes of hypersexual behaviour. Home care was terminated for this reason. Family members in particular had problems with his behaviour. It transpired that he was taking more levodopa than prescribed. After explaining the side-effect to the patient and after a special medication box was purchased which could be filled by the family, the patient's hypersexuality disappeared without deterioration of Parkinson's disease. Hypersexuality is a known, though not frequently recognised side-effect of dopaminergic anti-Parkinson therapy, especially levodopa. This side-effect is not life-threatening, but can have an enormous impact on the quality of life of the patient, his or her partner and environment. The mechanism is probably related to the pharmacological action of dopamine.