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Background: Preventing adverse drug reactions is the primary goal in pharmaceutical care, especially antibiotics as it can contribute to the deterioration of renal function. At 108 Central Military Hospital, Vietnam, managing renally cleared antibiotics (RCA) poses a considerable challenge due to its large facility with 2000 beds. Implementing a clinical decision support system (CDSS) holds promise in improving RCA dosing in patients with renal impairment. Methods: A retrospective study was conducted to assess antibiotic prescriptions in adults > 18 years old with an estimated glomerular filtration rate (eGFR) calculated by both Cockcroft-Gault and MDRD-4 formula under 90 mL/min/1.73 m² during two distinct periods: pre- and post-implementation of a CDSS, which included a drug compendium of 48 antibiotics requiring renal dose adjustment that was established through consensus among multiple summaries of product characteristics and specialized literature. Alerts were triggered when an antibiotic was prescribed within the threshold of the patient's eGFR. The impact of this CDSS was determined by comparing the percentage of inappropriate dosing between these periods. Results: Among 1012 total patients, 65.2% were over 65 years old, and 71.3% were male. The eGFR ranging from 60-90 mL/min was observed in 54.8% of patients during both periods. Of 1545 and 1730 antibiotic prescriptions in the pre- and post-period, 28.2% and 19.4% respectively, had inappropriate dosing (OR 0.61; 95% CI: 0.52-0.72; p<0.001). Inappropriate RCA dosing significantly decreased in the internal medicine department (OR 0.45; 95% CI: 0.36-0.57; p<0.001) and intensive care unit (OR: 0.57; 95% CI: 0.39-0.83; p=0.003), with marked reductions observed for cefoperazone/sulbactam, levofloxacin, and meropenem during the post-period (p<0.001). Conclusions: This study demonstrates the initial success of implementing a CDSS for antibiotic dosage prescriptions. Future research endeavors should focus on pharmacist interventions and integrate antibiotic indications into these recommendations to achieve optimal, personalized care. [ABSTRACT FROM AUTHOR]

Background A clinical decision support system (CDSS) linked to the computerized physician order entry may help improve prescription appropriateness in inpatients with renal insufficiency. Objective To evaluate the impact on prescription appropriateness of a CDSS prescriber alert for 85 drugs in renal failure patients. Setting Before-after study in a 975-bed academic hospital. Method Prescriptions of patients with renal failure were reviewed during two comparable periods of 6 days each, before and after the implementation of the CDSS (September 2009 and 2010). Main outcome measure The proportion of inappropriate dosages of 85 drugs included in the CDSS was compared in the pre- and post-implementation group. Results Six hundred and fifteen patients were included in the study (301 in pre- and 314 in post-implementation periods). In the pre- and post-implementation period, respectively 2882 and 3485 prescriptions were evaluated, of which 14.9 and 16.6% triggered an alert. Among these, the dosage was inappropriate in respectively 25.4 and 24.6% of prescriptions in the pre- and post-implementation periods (OR 0.97; 95% CI 0.72-1.29). The most frequently involved drugs were paracetamol, perindopril, tramadol and allopurinol. Conclusion The implementation of a CDSS did not significantly reduce the proportion of inappropriate drug dosages in patients with renal failure. Further research is required to investigate the reasons why prescribers override alerts. Collaboration with clinical pharmacists might improve compliance with the CDSS recommendations. [ABSTRACT FROM AUTHOR]

The application of appropriate rules for drug-drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed., Competing Interests: The authors have no potential conflicts of interest to disclose.