The Effect of a Real-Time Computerized Alert Program on the Prevention of Inappropriate Prescribing in Patients with Renal Impairment at Chaiyaphum Hospital

Abstract

Background: Medication prescribing for patients with renal impairment requires dose adjustments based on renal function. Therefore, the development of decision support systems can assist physicians in clinical decision-making, help prevent medication errors, and improve patient safety.

Objective: To evaluate the effectiveness of alerts and prescriber responses to a real-time computer alert program in preventing inappropriate prescriptions for patients with renal impairment.

Methods: This was a retrospective study that collected data from patients who were prescribed medications and either had a defined estimated glomerular filtration rate (eGFR) in the alert program or had no recorded eGFR value, over a 1-year period. Prescriber responses to alerts were followed up using hospital medical records over a 6-month period, from April 1, 2024, to September 30, 2024.

Results: A total of 11,338 alerts were generated. Of these, 87.56% were for patients who were prescribed medications without a recorded eGFR history, and 12.44% were for patients whose eGFR was at the defined threshold. For patients whose eGFR was at the limit, prescribers discontinued the medication in 14.89% of cases, continued the prescription and ordered eGFR monitoring at the next visit in 20.78%, and continued the prescription without ordering eGFR monitoring in 64.33%. For patients without a recorded eGFR history, prescribers continued the prescription and ordered eGFR monitoring at the next visit in 9.48%, and continued the prescription without eGFR monitoring in 90.52%.

Conclusion: The computer alert program demonstrated its ability to generate alerts as specified and supported prescribers in reviewing and adjusting medication orders appropriately for patients with renal impairment by using clinical data alongside the alerts.