The Supporting Clinical Rules in the Evaluation of Elderly with Neuropsychiatric disorders (SCREEN) project has developed software to support medication reviews in elderly patients, based on Clinical Rules (medical decision rules). These systematic medication reviews take place more and more frequently and carefully, and use more sources of patient data than the traditional, more observational approach. This method of medication review fits in well with the demand for more medication safety within the health care system. It is therefore essential to further develop more systematic and comprehensive medication monitoring methods in the coming years. Although medication monitoring methods in previous years were able to detect many signals, they also detected many irrelevant signals, while more serious problems were missed.
Enhancing the quality of medication reviews
The Dutch Health Care Inspectorate (Inspectie voor de Gezondheidszorg) is urging for the implementation of large-scale medication reviews, particularly in vulnerable elderly patients. However, the realisation of these reviews is limited by several factors: time constraints, lack of working knowledge in order to be able to systematically and proactively interpret a broad range of clinical pictures and treatment options in relation to clinically relevant chemical lab reports and other patient data. Also, there is a lack of standardised criteria to provide uniform, reproducible advice. After all, every health care professional takes action according to their own working knowledge and experience. Furthermore, a drug review could become redundant after one day, due to changes in circumstances. The implementation of Clinical Rules in the SCREEN project reduces the impact of these factors and thus significantly increases the quality of medication reviews.
As the analysis is automated, it requires minimal proactive time investment from health care professionals. For example: Clinical Rules is currently used at Orbis MC to evaluate 2,000 hospital and nursing home patients every day. The patient files are automatically imported and anonymised in Clinical Rules Reporter at night and evaluated in the Clinical Rules Engine. About 80% of the detected signals that are fed back to the Clinical Rules Reporter are deemed relevant and are dealt with by the hospital pharmacist. The way signals are dealt with (intervention or not, consultation with doctor etc.) is also coded and recorded in the Clinical Rules Reporter.
Clinical Rules supports the work of the hospital pharmacist and allows health care professionals to work more efficiently. Consequently, there is a greater focus on relevant medication safety issues, more relevant signals are detected based on more detailed patient data, and signal detections and interventions are shared more efficiently within the treatment team.
While developing Clinical Rules, it was essential that it would not depend on any specific software system used in health care institutions. An important and innovative aspect is that extracting and combining data from multiple sources guarantees this independence. Patient data from three different sources (medication files, lab reports and patient characteristics) are combined locally and uploaded to a Clinical Rules Engine in which medical decision rules are hosted centrally on a web server. The data are analysed efficiently in the Clinical Rules Engine and a report is made up and fed back for each incident. In this way, there is no need to build the 'intelligence' of Clinical Rules into every filing system.
Minimal time investment - maximum efficiency
The possibility of implementing a similar system at other locations has always been a priority for the department of Clinical Pharmacy at Orbis MC. Early 2013, a trial was conducted in approximately five nursing homes that use different software systems to compare the effect of Clinical Rules with regular care. The Clinical Rules system allows a very efficient and proactive way of signal detection, monitoring and treatment, while minimal time investment is required. It is already clear for current users that this system is essential to (hospital) pharmacists in order to provide purposeful medication safety reviews.
For more information regarding SCREEN and Clinical Rules , please contact Hugo van der Kuy or Bob van de Loo . Or join the group SCREEN project on Linkedin and start a discussion in the SCREEN-network.