What, if all alerts were specific - estimating the potential impact on drug interaction alert burden.

Purpose: Clinical decision support systems (CDSS) may potentially improve prescribing quality, but are subject to poor user acceptance. Reasons for alert overriding have been identified and counterstrategies have been suggested; however, poor alert specificity, a prominent reason of alert overriding, has not been well addressed. This paper aims at structuring modulators that determine alert specificity and estimating their quantitative impact on alert burden.

Development of a standardized knowledge base to generate individualized medication plans automatically with drug administration recommendations.

Aims: We aimed to develop a generic knowledge base with drug administration recommendations which allows the generation of a dynamic and comprehensive medication plan and to evaluate its comprehensibility and potential benefit in a qualitative pilot study with patients and physicians.

Methods: Based on a literature search and previously published medication plans, a prototype was developed and iteratively refined through qualitative evaluation (interviews with patients and focus group discussions with physicians). To develop the recommendations for safe administration of specific drugs we screened the summary of product characteristics (SmPC) of different exemplary brands, allocated the generated advice to groups with brands potentially requiring the same advice, and reviewed these allocations regarding applicability and appropriateness of the recommendations.

Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care.

Background: Upon admission to a hospital patients' medications are frequently switched to alternative drugs compiled in so called hospital drug formularies. This substitution process is a laborious and error-prone task which should be supported by sophisticated electronic tools. We developed a computerised decision support system and evaluated benefit and potential harm associated with its use.

Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms.

Purpose: We assessed the prevalence of difficulties in swallowing solid oral dosage forms in a general practice population. Reasons, nature, and characteristics of tablets and capsules causing such difficulties were investigated as well as general practitioners' (GP) awareness of these difficulties.

Methods: A questionnaire survey was conducted in 11 general practices and consecutive patients taking at least one solid oral dosage form for ≥4 weeks were invited to respond to a questionnaire at the practices and one at home.

[HeiCare®: a project aiming to improve medication communication across health care sectors].

Background And Objective: Changes between health care sectors represent a critical phase in long-term pharmacotherapy. The aim of the Hei CARE(®) project was to close the communication gap at the interface between primary care physicians (PCP), hospital physicians and patients, and to improve quality and safety of pharmacotherapy.

Methods: Physicians who enrolled patients with long-term pharmacotherapy were able to participate in the Hei CARE(®) project.

Misspellings in drug information system queries: characteristics of drug name spelling errors and strategies for their prevention.

Introduction: Efficient search for and finding drugs is essential for electronic drug information systems which, for their part, are prerequisites for computerized physician order entry systems and clinical decision support with the potential to prevent medication errors. Search failures would be critical: they may delay or even prohibit prescription processes or timely retrieval of vital drug information. We analyzed spelling-correction and error characteristics in drug searches and the suitability of auto-completion as prevention strategy.

Patient-specific electronic decision support reduces prescription of excessive doses.

Objectives: Prescription of excessive doses is the most common prescription error, provoking dose-dependent adverse drug reactions. Clinical decision support systems (CDSS) can prevent prescription errors especially when mainly clinically relevant warnings are issued. We have built and evaluated a CDSS providing upper dose limits personalised to individual patient characteristics thus guaranteeing for specific warnings.

Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system.

Objective: We investigated the effect of written drug information for senior clinicians on the incidence of drug-drug interactions (DDIs) and DDI-related adverse events in intensive care patients.

Design And Methods: A prospective controlled intervention cohort study was conducted in a medical intensive and intermediate care unit in a university hospital. From 1,062 consecutive intensive care patients, those 265 (control: 136, intervention: 129) with > or =8 concurrently prescribed drugs were included in the study (to include high-risk patients with polypharmacy).

[Medical problems and risks of switching drugs according to legal requirements of drug discount contracts in Germany].

Introduction: Since 2007 German health insurance funds may conclude discount contracts with pharmaceutical companies for individual drugs. According to German legislation pharmacies are liable to preferentially dispense these drugs to patients of the respective funds if the prescribed drug is identical regarding active ingredient, strength, package size, and route of administration, and is approved for the same indication. We aimed to assess the number and nature of clinically relevant differences between prescribed drug and its legal alternatives.

Characteristics of effective electronic mail messages distributed to healthcare professionals in a hospital setting.

Electronic mailing systems (e-mail) are an important means to disseminate information within electronic networks. However, in large business communities including the hectic environment of hospitals it may be difficult to induce account holders to read the e-mail. In two mailings disseminated in a large university hospital we evaluated the impact of e-mail layout (three e-mail text versions, two e-mails with graphics) on the willingness of its approximately 6500 recipients to seek additional electronic information and open an integrated link.

Rule-based standardised switching of drugs at the interface between primary and tertiary care.

Introduction: Changes in drug treatment are frequently mandatory with hospital admission and discharge because hospital drug formularies are generally restricted to about 3000 drugs as compared to the many times this number - 62,000 in Germany - that are commercially available. Without computerised support, the process involved with switching drugs to a corresponding generic or a therapeutic equivalent is time-consuming and error-prone.

Methods: We have developed and tested a standardised interchange algorithm for subsequent implementation into a computerised decision support system that switches drugs to the corresponding generic or a therapeutic equivalent if they are not listed on the hospital drug formulary.

Detection and prevention of prescriptions with excessive doses in electronic prescribing systems.

Introduction: Dose dependent adverse drug reactions are often caused by prescribing errors ignoring upper dose limits. Thus, computerised physician order entry incorporating maximum recommended therapeutic doses (MRTDs) might reduce prescriptions of excessive doses. We evaluated the suitability of MRTD information as published in the Summary of Product Characteristics (SPC) (MRTD(SPC)) or by the US Food and Drug Administration (MRTD(FDA)) and the value of Defined Daily Doses (DDD, World Health Organisation) as knowledge bases for an alerting system.