Clinical Decision Support and Medication Management

The Health Information Management and Management Systems Society (HIMSS) defines Clinical Decision Support (CDS) as "a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery." Choosing a certified electronic health record technology (CEHRT) which contains CDS tools can help facilitate providers' improved management of patient medications, resulting in safer, better-quality care for patients and overall improved health outcomes. Compliance monitoring, alerts and population management tools are components of CDS tools that are especially useful to physicians when managing patients' medications. According to the Agency for Healthcare Research and Quality (AHRQ), CDS tools improve medication management-related tasks in six key areas, including: Medication Selection and Reconciliation, Ordering, Monitoring, Verification and Dispensing, Education, and Administration.

Medication Selection and Reconciliation

Drug CDS tools:

• Help a prescriber select a safe, effective and appropriate medication that is tailored to the specific patient and circumstances.

• Base the medication selection on clinical evidence, best practices, the patient's individual characteristics, and cost-effectiveness.

• (When making a medication selection) Consider relevant patient information such as past medical history, weight, height and age, as well as pertinent disease management knowledge like evidence-based best practice treatment approaches, and drug information to address dosing, side effects, costs, interactions, contraindications and the like.

• Support medication reconciliation by providing an accurate, complete list of the patient's medications, along with medication identification and therapeutic use information.

Ordering

Drug CDS tools:

• Help the user create a medication order/prescription for the patient to take a drug or for the drug to be administered.

• Provide patient and condition-specific dosing recommendations.

• Conduct automatic checks that prevent contraindications, therapeutic duplications, drug-drug interactions, drug-lab interactions, drug-disease interactions and clinically significant allergies. They also help ensure that the medication is prescribed for the correct dose, route and frequency.

Monitoring

Drug CDS tools:

• Verify that the patient adheres properly to the medication regime.

• Help track adverse events like allergies, side effects or interactions.

• Help provide feedback and input about patient medication use across care settings, which assist providers with designing safer and more effective treatments. For example, if a patient experienced an allergy to a certain antibiotic, the provider would know to prescribe an alternative antibiotic the next time the patient required a similar medication.

Verification/Dispensing

Medication CDS tools:

• Double check for interactions, appropriateness/contraindications, right dose/route/frequency/timing.

• Help the provider match the prescription or order to the correct dose and dose form.

• Match prescription/order to correct dose and dose form.

• Check for proper concentration and volume to minimize pump programming errors, incompatibilities, and dispensing waste — important especially in pediatrics (for example, using 500-mL instead of 1000-mL bags when appropriate, and the like).

Education

Medication CDS tools:

• Engage patients in effective medication use and help the patient understand how and the reasons why to properly take medications, including: indication, administration, and desired effects; how to appropriately store and handle medications; potential adverse effects to be vigilant for and how to address them; ensure patient understanding of information whether communicated via discussion, handouts, patient portals/kiosks, PHRs, and/or audio/video material and other media.

• Engage caregiver/parent when needed to support patient.

Administration

Drug CDS tools:

• Positively identify the patient and the medication.

• Assess patient and document pertinent parameters (such as blood pressure, heart rate, blood glucose, pain level) prior to administration.

• Check for incompatibilities/interactions, such as between parenteral medications, between medications and foods, etc.

• Recheck right dose/route/frequency, administration technique and timing, monitoring guidelines.

• Provide a reminder or guidance if medications are not administered at the appropriate time or are delayed or missed.

Source: The Agency for Healthcare Research and Quality