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First published March 31, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1783
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J Am Med Inform Assoc. 2005;12:383-389. DOI 10.1197/jamia.M1783.
© 2005 American Medical Informatics Association

Case Report

Implementing a Commercial Rule Base as a Medication Order Safety Net

Richard M. Reichley, RPh, Terry L. Seaton, PharmD, Ervina Resetar, MS, Scott T. Micek, PharmD, Karen L. Scott, RPh, Victoria J. Fraser, MD, W. Claiborne Dunagan, MD and Thomas C. Bailey, MD

Affiliations of the authors: Center for Healthcare Quality and Effectiveness, BJC HealthCare and the Department of Medicine, Washington University School of Medicine (RMR, ER, VJF, WCD, TCB); Department of Pharmacy, Barnes-Jewish Hospital (STM); St. Louis College of Pharmacy (TLS); Department of Pharmacy, Christian Hospital (KLS), St. Louis, MO.

Correspondence and reprints: Richard M. Reichley, RPh, 600 S. Taylor Avenue, 90-94-233, St. Louis, MO 63110; e-mail: <rmr9716{at}bjc.org>.

Received for publication: 12/22/04; accepted for publication: 03/06/05.

A commercial rule base (Cerner Multum) was used to identify medication orders exceeding recommended dosage limits at five hospitals within BJC HealthCare, an integrated health care system. During initial testing, clinical pharmacists determined that there was an excessive number of nuisance and clinically insignificant alerts, with an overall alert rate of 9.2%. A method for customizing the commercial rule base was implemented to increase rule specificity for problematic rules. The system was subsequently deployed at two facilities and achieved alert rates of less than 1%. Pharmacists screened these alerts and contacted ordering physicians in 21% of cases. Physicians made therapeutic changes in response to 38% of alerts presented to them. By applying simple techniques to customize rules, commercial rule bases can be used to rapidly deploy a safety net to screen drug orders for excessive dosages, while preserving the rule architecture for later implementations of more finely tuned clinical decision support.




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