1. Cli ni cal D eci si on
Suppor t System

2. A dver se D r ug E vents ( A D E s)
- Any injury secondary to medication use.
- Divided into:
1. Non-preventable
- inherently associated with medication
therapy
2. Preventable
- those that cause injury to the patient
that could have been prevented.
3. Potential
- an ADE that could have occurred as a result
of an error but (fortunately) did not.

3. M edi cati on E r r or s

4. Clinical Decision Support System
Terms
Datum - plural form “data”
- the value of a specific parameter for a
specific object
Knowledge – derived from the formal or
informal analysis of data
Data base – a collection of individual
observations without any
summarizing analysis.
Knowledge based system
- the result when knowledge is applied to a
system or database.

5. Clinical Decision Support
System (CDSS)
- software that is designed to be a
direct aid to clinical decision-making
- convert patient data essential for the
clinician to make the right decisions
into usable information at the time of
decision making.

6. Why is there a need for Decision
Support Systems?
• Increasing number of scientific articles produced
each year makes it difficult for clinicians doing
research, to access the right information among the
massive volumes of research.
• Medical and medication errors are often the result
of poorly designed system, thus the conclusion that
health care facilities should rely more on automation
to make it less error prone.
• Computerization has lead to increase of patient-
specific data that can be used in decision support
algorithms.

7. • Focus on quality of care and the increased availability of
electronic data have resulted in greater performance
requirements for health care organization
• Decision Support could improve the performance of
Pharmacy information system by integrating additional
patient specific information, resulting in more clinically
relevant recommendations

8. Elements if CDSS
• Knowledge base
Translates scientific knowledge into computer-
interpretable decision algorithms
• Rules engine
Retrieves patient-specific, often stored in multiple
databases, and checks whether the criteria set in the
knowledge base are met.
• Software
Allows the user to create clinical decision algorithms
and generate recommendations

9. Elements of a CDSS (diagram)
BCMA
Laboratory
Guidelines
Rules software Knowledge
DATA Engine base
CPOE
software
Infusion Data
EKG Monitoring Output
to user

10. SS
of CD
Uses

11. f S S
o D
s C
e n
p i
ym
t e 1. System for diagnosis
4 t 2. Reminder systems for Prevention
s 3. Systems for Disease Management
y
s 4. Systems for Drug Dosing and Prescribing
- 2 categories:
a. Basic CDSS
b. Advanced CDSS

12. Basic CDSS
- Includes the following:
 Drug allergy checking
- presents an alert when a clinician orders a
medication to which the patient has an
electronically documented allergy
- considered as an important patient safety
feature.
 Basic Dosing Guidance
- basic decision support, even within CPOE can
dramatically improve appropriate dosage of
medication by providing the clinician a list of the ff:
1. patient-specific dosage parameters.
2. drug-specific dosage parameter
3. indication-specific dosage parameters

13. - this often occurs in the following situations:
a. patients with more than one clinician
b. switching IV therapy to oral therapy
without discontinuing the original IV
order
c. prescribing multiple drugs from the
same drug class (antimicrobials,
opioids, immunosuppressant, and
insulin)
d. dosage tapering with different doses
for the same drug
- extensive customization of duplicate order
checking and selective alerting are needed to
prevent excessive irrelevant alerting.

14.  Formulary Decision Support
- a formulary is a selection of drugs covering
all therapeutic areas that can be used in the
hospital.
- basic decision support can improve
formulary compliance by assisting clinicians
in the selection of formulary options over
non-formulary options.
 Duplicate Therapy Checking
- duplicate therapy occurs when more than
one regimen of a single drug or multiple
regimens of different medications with similar
therapeutic effects are prescribed.

15. Drug-Drug Interaction Checking
- one of the most frequently
used types of CDSS.
- however, as with duplicate
order checking, drug-drug
interaction checking is
associated with large
numbers of clinically
unimportant alerts.

16. Advanced Clinical Decision Support
- Advanced medication-related decision support should be
implemented only after basic decision support is in place
and working well, with good user acceptance.
- require many factors to determine accurately what is a
safe and appropriate dosage for a particular patient.
- These factors are:
age renal function
weight liver function
height fluid status
indication for the drug concomitant medications
genetic predisposition reaction to previous
medications

17. - Advanced CDSS includes the ff. subcategories:
 Dosing support in special populations
- advanced decision support can integrate
the parameters for dosage
recommendations in certain cases.
- this program substantially decreased the
number of adverse events, number of
days of unnecessary therapy, and costs.
 Drug-Laboratory interaction checking
- decision support remind physicians to
request the appropriate blood samples at
the appropriate time.

18.  Drug-Disease (contraindication) checking
- the most important contraindications
are renal impairment and hepatic
impairment
 Drug pregnancy checking
- an important category of advanced
decision support, whose biggest
challenge would be to determine the
pregnancy status of the patient accurately.
- electronic health records should allow
clinicians to document the pregnancy
status explicitly (is pregnant, might be
pregnant, etc.)