SHM Converge Scientific Abstract ePoster Gallery-Effect of Medication Decision Support on Inpatient Pharmacist Recommendations to Hospital Medical Teams

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This prospective pre-post time-motion study evaluated whether real-time clinical decision support (CDS) could improve inpatient pharmacists’ medication-regimen recommendations during rounds at two academic medical centers: Mass General Brigham and Vanderbilt University Medical Center. Ten pharmacists were trained to use Synapse Medicine’s stand-alone CDS tool, which provides medication appropriateness recommendations based on EHR data and evidence-based criteria. Researchers observed 40 weekday shifts per site over 6 months before and 6 months after implementation using TimeCaT software.<br /><br />Outcomes included the number of recommendations per patient and time spent using reference tools per patient and per recommendation. Analyses used mixed models with random effects for pharmacist.<br /><br />Synapse use was much higher at Vanderbilt than at Mass General Brigham. After implementation, pharmacists spent more time using reference software, especially at Vanderbilt. The number of medication recommendations per patient decreased modestly overall. Among recommendations specifically about starting/stopping medications and changing dose or frequency, medication initiations decreased from 34% to 22%, while discontinuations increased from 12% to 15%.<br /><br />Overall, use of commercially available CDS by inpatient pharmacists was associated with slightly more time spent per recommendation and a modest reduction in the number of medication recommendations per patient, particularly at the site with greater usage. The changes in recommendation patterns may have positive patient-safety implications, including fewer medication starts and slightly more discontinuations. However, because the tool was stand-alone rather than fully integrated into the EHR, the authors conclude that fuller EHR integration is likely needed for greater impact and easier adoption.

Asset Subtitle

Amanda S. Mixon

Meta Tag

Author List Amanda S. Mixon, Deonni Stolldorf, Domitille Oddon, Guillaume L. Martin, Jeffrey L. Schnipper, Louis Letinier

Category Research

Concept Clinical Decision Support

Concept Medication Regimen Appropriateness

Concept Medical Recommendation

Concept Medication Safety

Concept Hospitalized Patients

Distinguished Non-Finalist

Presenter Organization Vanderbilt University Medical Center

Presenting Author Amanda S. Mixon

Track Patient Safety

Keywords

clinical decision support

inpatient pharmacists

medication recommendations

time-motion study

EHR data

academic medical centers

pharmacist rounds

medication safety

stand-alone CDS tool

mixed models

Clinical Decision Support

Medication Regimen Appropriateness

Medical Recommendation

Medication Safety

Hospitalized Patients