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دومین کنگره انفورماتیک پزشکی و هفتمین همایش سلامت الکترونیک
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| عنوان فارسی |
توسعه سیستم تصمیم یار مبتنی بر قواعد برای تجویز داروهای بیماران با ریسک خطر بالا با نارسایی کبدی و کلیوی |
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| چکیده فارسی مقاله |
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| کلیدواژه‌های فارسی مقاله |
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| عنوان انگلیسی |
Development of a rule-based clinical decision support system for high risk patients with renal and hepatic impairments |
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| چکیده انگلیسی مقاله |
Background: Introduction: Inadequate monitoring of laboratory values when prescribing medications can cause medication errors and adverse drug events. Computerized physician order entry (CPOE) systems in combination with clinical decision support tools have the potential to decrease these medication errors by improving the quality of prescriptions with regards to lab values. We aimed to develop a rule based clinical decision support system (CDSS) to support clinicians in prescribing medications for patients with renal and hepatic impairments. Materials and Methods: A prospective cross-sectional study was conducted to record all prescriptions and laboratory liver and renal function tests of all kidney recipients referred to the kidney transplantation clinic of Urmia University of Medical Sciences during February and March 2017. Descriptive statistical tests were used to determine the common medications prescribed for these patients. Main pharmacology textbooks and references including “Mosby’s diagnostic and laboratory test reference”, “up-to-date” and “prescriber’s digital reference” (the PDR®, the most recognized drug information reference available in the U.S.) were used to extract IF & THEN rules pertaining to renal and hepatic considerations when prescribing medications. Then, a CDSS system was developed to alert drug-lab (renal and hepatic function) interactions when the most common medications in our study were prescribed. The performance of the system was tested using the data collected in the first phase of this study. Results: For 595 kidney transplant recipients included in our study, 29 immunosuppressive and non-immunosuppressive medications were prescribed most commonly. Among them, 18 medications required adjustments based on hepatic function and 17 needed adjustments with regards to renal function (among which 9 requiring both). Based on this information and IF & THEN rules and the alert contents extracted from the main references, a rule based drug-lab interaction alerting CDSS was designed and linked into the CPOE system and the computerized lab records of a home-grown clinical transplant management system, which included the results of renal and hepatic function tests. The performance of this CDSS system in detecting drug-lab interactions was pilot tested using medication lists and liver and renal laboratory values of patients included in our study population. Conclusion: Our study shows the feasibility of developing a drug-lab CDSS for a high risk patient population. This system provides clinicians with an automatic check of renal and hepatic considerations whenever they prescribe medications for their patients and thereby have the potential to improve the safety of medication prescriptions. We are planning to implement this system in daily workflow of our transplant clinic as a module of a home-grown clinical transplant management system in near future. We hope the insights gained in our study will inform the design of similar systems for other high risk patients. |
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| کلیدواژه‌های انگلیسی مقاله |
Drug-lab Interactions، Clinical Decision Support Systems، up-to-date، Medication Errors، Kidney Transplant |
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| نویسندگان مقاله |
zahra niazkhani - urmia university of medical sciences
habibollah pirnejad - urmia university of medical sciences
mahsa fereidoni - urmia university of medical sciences
parastu amiri - urmia university of medical sciences
afshin shiva - urmia university of medical sciences
khadijeh makhdoomi - urmia university of medical sciences
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| نشانی اینترنتی |
http://mieh-2018.modares.ac.ir/browse.php?a_code=A-10-143-2&slc_lang=fa&sid=1 |
| فایل مقاله |
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| کد مقاله (doi) |
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| زبان مقاله منتشر شده |
en |
| موضوعات مقاله منتشر شده |
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| نوع مقاله منتشر شده |
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