Drug monitoring may be improved by the use of health information technology and clinical pharmacists
Interventions to improve medication safety have mainly focused on the physician ordering stage by providing real-time clinical decision support. Based on a systematic review of a limited number of available studies on the use of health information technology (health IT) to improve monitoring of prescription drugs in ambulatory care patients, passive (nonblocking) alerts are likely to have little or no effectiveness. Alerts that require physicians to navigate multiple steps also seem likely to fail, according to findings from a systematic review. Interventions that employ a team of clinical pharmacists are more likely to reduce drug monitoring errors.
Patients are at risk when potentially toxic medicines are dispensed without the performance of appropriate drug monitoring. Examples of errors include the failure to monitor potassium levels among patients receiving potassium supplementation and the failure to monitor liver and thyroid function among patients receiving amiodarone. To improve drug monitoring in ambulatory patients, the authors undertook a systematic review of current evidence on health IT interventions. The review identified seven relevant studies.
Of the four studies that assessed real-time interventions using alerts to physicians at the time of medication ordering, three showed no effect, while one study suggested modest improvement in monitoring. In contrast, all three of the studies incorporating asynchronous use of health IT that employed a team of clinical pharmacists reported the greatest reductions in drug monitoring errors. These interventions created a new workflow that relieved some of the burden of drug monitoring from the prescribing clinicians. However, this approach may not be feasible for smaller clinical practices and may not be affordable even to larger health care systems, note the researchers. Their systematic review was supported by the Agency for Healthcare Research and Quality (HS17201).
See "Using health information technology to improve drug monitoring: a systematic review," by Geoffrey L. Hayward, M.D., M.P.H., Aaron J. Parnes, M.D., and Steven R. Simon, M.D., M.P.H. in Pharmacoepidemiology and Drug Safety 18, pp. 1232-1237, 2009.
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