Table 5.
CDSS notifications assessed as relevant but confirmed as non-relevant
DRP notifications | Reason scored as non-relevant | Action needed to improve algorithm |
---|---|---|
Renal failure and Rosuvastatin: contra-indicated in renal failure | Renal function was 14 ml/min with a daily dose of 10 mg Rosuvastatin, which is acceptable when the dosage is slowly increased | Introduce Rosuvastatin dosage limits of renal dysfunction into the algorithm as well as start date of prescription |
Metformin and unknown vitamin B12 level | Vitamin B complex is prescribed. Vitamin B12 levels are regarded as irrelevant when supplemented | Prescription of vitamin B complex should be included in the algorithm. Furthermore, determined vitamin B12 levels should also be included in the algorithm |
Tramadol and seizure: Tramadol should be used with caution in patients with a history of epilepsy and those on concomitant seizure threshold-lowering medication. Consider switching to other pain medication | Tramadol is contraindicated in epilepsy, associated drugs (nortriptyline) is prescribed for depression | Nortriptyline should be removed from the algorithm since this is not a standard therapy for epilepsy |
Renal Failure and pregabalin: initial dose 75 mg per day, maximum dose 300 mg per day | Renal function of 43 ml/min with a dosage of 150 mg daily. Maximum dose was not exceeded | The algorithm should be adjusted to take into account the starting date of the prescription |
Anticoagulation therapy and INR: acenocoumarol | High INR, but already given anti-dote vitamin K | Include the prescription of the anti-dote vitamin K into the algorithm |
Use of acetosal, dipyridamol, clopidogrel, prasugrel without a HMG CoA-reductase inhibitor therapy (statin) | Patients were considered too old of age for HMG CoA-reductase inhibitor therapy | A frailty indicator might be considered for inclusion to determine if a HMG CoA-reductase inhibitor therapy should still be prescribed |