Clinical decision support for drug related events: Moving towards better prevention

Table 3 Examples of preventative alerts

Ref.	Drug related hazardous condition for alert detection	Adverse drug event prevention	Criteria for prevention alert
Rommers et al[43]	Before a DRHC occurs-eventually hemoglobin drop	Bleed	Elderly patient who is not taking a PPI and is started on an NSAID
Moore et al[42]	Hypoglycemia	Mental status changes	Receiving a new antidiabetic agent and 3 consecutive low glucose results that are steadily declining over a period of time
Moore et al[42]	Hypokalemia	Dysrhythmia	Drug started causing hypokalemia + potassium level under 3.8 mEq/L
Moore et al[42]	Thrombocytopenia	Bleed	Drug started causing thrombocytopenia and platelets slowly decrease over 50000/mm3 within 4 d
Moore et al[42]	Hyperkalemia	Dysrhythmia	Drug started causing hyperkalemia + potassium level over 5.5 mEq/L and increasing slowly over 72 h
Raschke et al[35]	C. difficile	Permanent gastrointestinal disorders (i.e., irritable bowel syndrome, colectomy)	Antidiarrheal and recent aggressive antibiotic therapy OR history of Clostiridum difficile
Rommers et al[43] and Silverman et al[44]	Before DRHC occurs-eventually digoxin level elevated	Dysrhythmia, confusion	Patient with 3 consecutive increasing serum creatinine levels and also on digoxin therapy (or other renally cleared drugs would apply such as metformin, enoxaparin, vancomycin)
Rommers et al[43]	Constipation	Bowel obstruction	Narcotic started recently and patient has a history of constipation or narcotic started recently and patient has not had a bowel movement in over 24 h
Van Doormaal et al[45]	Constipation	Bowel obstruction	Opioid prescribed without a co-prescription of a stimulant laxative
Van Doormaal et al[45]	KDIGO stage 1 AKI-in the future biomarkers may be the early sign of AKI before SCr rise	KDIGO stage 3 AKI	Sulfonamide urea derivate is prescribed and the patient has a creatinine clearance of less than 10 mL/min
DiPoto et al[46]	Before a DRHC occurs-eventually hemoglobin drop	Bleed	Patient has epidural and started on an anticoagulant or antiplatelet
DiPoto et al[46]	Sedation	Mental status changes	Fentanyl patch and no documented history of long-acting opioid use
Silverman et al[44] and Jha et al[47]	ALT rising	Hepatic failure	Hepatotoxic drug and ALT increase by 20%
Silverman et al[44] and Jha et al[47]	Osmolarity increasing	Mental status changes, risk of death	Lorazepam use and osmolarity increasing

DRHC: Drug related hazardous condition; KDIGO: Kidney Disease Improving Global Outcomes; AKI: Acute kidney injury; ALT: Alanine aminotransferase.