Development of an electronic patient prioritization tool for clinical pharmacist interventions.

PURPOSE A software-based tool to help prioritize inpatients for adverse drug event (ADE) prevention initiatives is described. SUMMARY The clinical pharmacy department of a New Zealand hospital developed the Assessment of Risk Tool (ART), an application for monitoring prespecified clinical "flags" (some derived from the Institute for Healthcare Improvement's ADE trigger tool) for high-risk medication use and other ADE risk factors. The ART permits ADE risk assessment in virtual real time (i.e., medication-use data and other clinical information are updated multiple times daily). Each of the 38 flags captured by the ART is assigned a weighted score; the item scores are summed to provide a total ART score indicating low, medium, or high ADE risk, and patients are prioritized by the ART score for pharmacist interventions such as clinical review and discharge coordination. In the first 18 months after ART implementation, the average number of patients receiving medication reconciliation each month increased from 280 to 500. During one 8-month period, 765 high-risk patients were prioritized for discharge services and 526 medication errors (MEs) were prevented, including 174 errors deemed to pose a threat of moderate-to-major patient harm. The tool has been well received by clinicians and has generated interest among other New Zealand hospitals. CONCLUSION By facilitating the identification and monitoring of patients at high risk for MEs and ADEs, the ART has enabled one hospital's clinical pharmacists to conduct interventions such as medication reconciliation and clinical review in a more timely and targeted manner.