4CPS-022 The effect of digital clinical decision support on pharmacotherapy in hospitalised (morbidly) obese patients: a prospective intervention study

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Background and Importance The pharmacokinetics and dynamics of medication can be altered in (morbidly) obese patients. Standard medication doses may be suboptimal in these patients and adjustments based on body mass index (BMI) or body weight (BW) may be needed. Digital clinical decision support (eCDS) may help optimise pharmacotherapy in these patients. Aim and Objectives The aim of this study was to assess the effect of eCDS on adjustments in pharmacotherapy based on BMI or BW in hospitalised (morbidly) obese patients. Material and Methods This prospective intervention study with retrospective baseline measurement included hospitalised patients ≥ 18 years with BMI ≥ 30 kg/m2 and/or BW ≥ 90 kg from 1 January 2022to 30 September 2022 (pre-eCDS group) and from 10 October 2022 to 25 November 2022 (post-eCDS group). In the intervention period, hospital pharmacy recommended pharmacotherapy adjustments to prescribers based on eCDS. eCDS is a tool, integrated in the hospital’s electronic health record system, that detected patients whose medication order(s) needed to be adjusted to BMI or BW. Study outcomes were (i) prevalence of medication orders adjusted to BMI or BW pre-eCDS versus post-eCDS, (ii) prevalence of post-eCDS patients with ≥1 medication orders resulting in a recommendation for adjustment, including medication details, (iii) number and percentage of recommendations that actually led to an adjustment in pharmacotherapy, including reasons for rejecting a recommendation. Results In the post-eCDS group pharmacotherapy was significantly more often adjusted to BMI or BW: 77.7% (912 of 1,173 medication orders) post-eCDS vs 58.2% (3,519 of 6,049 medication orders) pre-eCDS (p<0.0001). Post-eCDS 328 patients had ≥1 medication order(s) resulting in a recommendation for adjustment. The majority of recommendations and adjustments were for nadroparin, 93% (324/349) and 89% (163/186) respectively. 186 of 349 (53.3%) recommendations actually led to an adjustment in pharmacotherapy. The main reason for not accepting a recommendation by a physician was near discharge from hospital: 90.8% (148 of 163 recommendations). Conclusion and Relevance Implementation of eCDS in hospital pharmacy led to a significant increase in medication orders adjusted to BMI or BW, in (morbidly) obese patients. It is important to implement and evaluate such interventions to optimise treatment for this growing population. References and/or Acknowledgements Conflict of Interest No conflict of interest.

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