Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors

Abstract

Objective: Computer-prescriber order entry (CPOE) systems that lack clinical decision components actually increase errors and cause harm rather than the opposite. Recent studies have also demonstrated that dosing errors, typing errors, or miscommunication with other systems are the most common CPOE errors. Our objective was to develop an antibiotic dosing calculator and implement it in the CPOE system while integrating the role of the clinical pharmacist in the CPOE in order to minimize dosing errors in the prescription of antibiotics.

Methods: A database was prepared using dosage information for 13 renal function-related antibiotics. The dosages in the database ranged from the standard to the maximum dosage based on various creatinine clearance (CL(cr) levels. The antibiotic dosage monitoring system was developed to screen the entire inpatient database for inappropriate antibiotic dosage regimens and record the results as an Excel document.

Main outcome measure: We tracked the frequency of calculator utilization by physicians, the acceptance rate of recommendations from the calculator and pharmacists, the inappropriate antibiotic dosage regimen prescriptions, and the antibiotic-related renal function deterioration. The relative risk (RR) with 95% confidence intervals (CI) was used to calculate the risk of inappropriate antibiotic dosage prescription, the deterioration in renal function when antibiotics were used.

Results: From 2005 to 2008, 38,647 antibiotic prescriptions were recorded in the CPOE system. The instances of inappropriate antibiotic dosage prescriptions were decreased by ~ 80% after the calculator was implemented (RR, 0.18 – 0.23; p < 0.001), and the incidence rates of renal function deterioration were lowered from 12.39% to 9.47%. The frequency of antibiotic calculator utilization by physicians (from 239 times/ year in 2005 to 3,480 times/year in 2008) and the acceptance rate of the calculator’s dosage recommendations (from 68.2% in 2005 to 94.7% in 2008) both increased during the study period. The average acceptance rates of pharmacist recommendations by physicians were 97.65%.

Conclusions: Integration of the CPOE decision-supporting system and the clinical pharmacist monitoring practice can help physicians provide appropriate antibiotic dosage regimens and decrease the incidence of dosing errors that could be decreased concerned patients with impaired renal function.