Abstract:

Introduction: In the United States, more than 250,000 deaths are caused annually by medication errors. Pharmacists play a crucial role in preventing medication errors and optimizing pharmacotherapy. Moreover, clinical decision support (CDS) tools are continually developed to help clinicians improve medication safety. While pharmacist roles are expanding, the vast majority of CDS has been targeted at prescribers. Our goal was to evaluate the literature to understand the impact of recent CDS targeted at clinical pharmacists.

Hypothesis: Recent CDS has been increasingly developed for clinical pharmacists in the inpatient setting to reduce medication errors and optimize pharmacotherapy.

Study design: Systematic Review

Methods: We searched MEDLINE, EMBASE, and Cochrane Central databases from 2010 to 2019. We included randomized controlled trials (RCTs) and quasi-experimental studies evaluating a CDS tool developed for clinical pharmacists at inpatient setting. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Additionally, we assessed study quality using Newcastle-Ottawa Scale.

Results: Our search resulted in 3542 studies. Following title-abstract screening (498) and full-text review (87), 13 studies met our inclusion criteria. Among 13 studies, 7 were RCT and 6 were quasi-experimental study designs. We found CDS interventions significantly improved patient safety (5), quality use of medication (4), and quality of care (4). Fives studies (38%) evaluated a CDS tool developed for an expanded role of clinical pharmacists.

Conclusion: Our results show that CDS may support clinical pharmacists in preventing medication errors and optimizing pharmacotherapy. We found that CDS tools have been developed for pharmacist roles outside order verification, which suggests healthcare institutions are beginning to recognize pharmacists as leaders in safe and effective pharmacotherapy.