Improving clinical decision support in pharmacy: Toward the perfect DUR alert

Abstract

The cornerstone of every health care profession is decision making. Historically, the decisions made by pharmacists have focused on ensuring the accuracy and physical integrity of the pharmaceutical product delivered to the patient in strict compliance with the prescriber's order. As the role of the pharmacist evolved over the past half century, the focus of decision making progressively shifted from a product-centric orientation to optimizing the interaction that occurs between the pharmaceutical product and the patient. Toward that end, prospective drug utilization review (pro-DUR) represents, perhaps, the quintessential expression of the pharmacist's con temporary clinical role. Fueled by evolving practice standards, innovations in information technology, and legal mandates such as The Omnibus Budget Reconciliation Act of 1990, computer-assisted pro-DUR systems have become a ubiquitous component of pharmacy practice. While these data-driven clinical decision support systems have clearly demonstrated their ability to improve the quality and safety of medication delivery and use, they have yet to fully achieve their promised potential. Doing so will require recognition of continuing shortcomings and a shared commitment by all stakeholders to develop and adhere to best practice guidelines that will better ensure that alerts received by practitioners are valid, interpretable, clinically significant, and actionable.