Table 2.
Source | Type of CDS alerts | Data sources used to identify ADEs | Mechanisms used to identify and classify ADEs |
---|---|---|---|
Evans et al.28 1994 | Alerts pharmacists when a drug was inadvertently ordered to which a patient was allergic | Nurse charts; nurse/pharmacist reports; laboratory results; pharmacy orders | Computer-identified ADE was verified by nurse or clinical pharmacist based on Naranjo method39 (definite, probable, possible/unlikely) |
Bates et al.23 1998 | Menu of medications; default doses and range of doses; relevant lab results; consequent orders; limited drug-allergy checking, drug–drug interaction, and drug-laboratory checking | Incident reports from nurse/pharmacist; information from unit staff; medical records review | Review of data sources for possible drug-related incidents; independent review by 2 reviewers; structured criteria used to determine occurrence, severity, and ADE preventability15 |
Bates et al.24 1999 | Hospital-approved standard lists; relevant laboratory results; detect drug-allergy interactions for the most commonly allergic drug families; duplicate order warning; life-threatening drug–drug interactions and drug-laboratory checks notification | Pharmacist reporting; nurse reports; pharmacist medication sheets review; medical records review | Independent review by 2 reviewers; structured criteria used to determine occurrence, severity, and ADE preventability15 |
Peterson et al.30 2005 | Highlighted default dose and frequency; suggested substitution for psychotropic medications based on default dose and frequency for elderly patients | Electronic medical records; hospital inpatient reporting system; altered mental status score | Analysis of administrative data |
Upperman et al.32 2005 | Most drugs cross-referenced in an online formulary; rules warning of unfavorable clinical parameters in patients status; potential drug–drug, drug–allergy, and drug–food interactions and potential medication errors alerts | ADE rate data pre and post introduction of CPOE implementation | Med-Marx32 categorization system (no harm or harm ADE) used to identify errors in prescribing |
Evans et al.26 1995 | Maximum 24-h white blood cell count and temperature; calculates renal function and estimated creatinine clearance; antibiotic allergies and current antibiotic therapy; uses all patient admission and patient allergies, drug–drug interactions, toxicity, and cost in selection and type of antibiotic therapy; calculates dosage and frequency | Computerized medical records; prospective ADE surveillance | Not specified |
Evans et al.27 1998 | Decision-support logic suggests an antiinfective regimen; uses patient allergies, drug–drug interactions, toxicity, contraindications, and cost in the selection of antibiotics; measures renal and hepatic function to calculate dose and dosing interval | Prospective ADE surveillance | Not specified |
Colpaert et al.25 2006 (RCT) | Commonly used drug therapy with dose and dosage schemes for renal insufficiency and for patients with severe liver dysfunction; allergies, clinically important interactions, and drug-related complications; protocol-based facilitated medication prescription for specific patient groups | Medication orders; medical and nursing files; laboratory data | Clinical pharmacist analysis of every medication order for possible error; independent panel evaluation of the severity of errors; used NCC MERP guidelines for classifying errors |
Mullett et al.29 2001 | Laboratory results review and summary report; the pediatric antiinfective management program | Computer alerting program; pharmacist-recorded ADE | Pharmacy staff monitoring and recording |
Steele et al.31 2005 | Rule based drug–laboratory interactions alerts; can order any rule-associated lab test | Automated order entry forms; random sample of chart reviews | Random sample of chart reviews using the Naranjo scoring scale39 |
CPOE: computerized physician order entry, CDS: clinical decision support, ADE: adverse drug event, NCC MERP: National Coordinating Council for Medication Error Reporting and Prevention