Clinical Rules

Protégé

In cooperation with hospital pharmacists, Clinical Rules were formulated that relate the monitoring of specific types of medication to the clinical-chemical parameters of a patient. The rules that must be applied in medication monitoring are modeled in Protégé, a free, open source ontology editor and knowledge-base framework that was developed by the Stanford University, USA.

This framework contains 'If > Then' rules. 'If' (a combination of) prerequisites or preconditions are met, 'Then' (a number of) conclusions or post conditions can be deduced. For example:

'If" metformine is prescribed and the patient has a creatinine clearance of 28.7 ml/min/1.73m2
'Then' the recommendation is: metformine is contraindicated

G-Standard and individual Clinical Rules

The Clinical Rules are based on national guidelines published in the G-Standaard by KNMP/WINAp/Z-Index. The G-Standaard is (one of) the world’s most comprehensive and up-to-date bodies of information to offer structure, safety assessment and decision support in relation to medication. All Clinical Rules are checked and verified by the hospital pharmacist who uses the application.

Pharmaps Medication Safety PLUS also offers the possibility to add individual Clinical Rules. The result is a set of uniform, centrally registered 'rules'. Every physician or pharmacist receives the same signals and the same suggestions and advice.

Examples

In the module 'renal failure', the Clinical Rules cover medication that may be dangerous for patients with a reduced kidney function. It is also possible to check for an improved kidney function.

Relating the serum potassium level monitoring to medication that alters potassium levels, is also part of Pharmaps Medication Safety PLUS. To illustrate this: the entire advantage of using of spironolacton to treat heart failure –as measured in large clinical studies– is undone in clinical practice by arrhythmia due to increased serum potassium levels.

Continuous monitoring

Pharmaps Medication Safety PLUS does not only apply the Clinical Rules at the time of prescription, it also makes repeated checks. Depending on the requirements of the user, these checks can be performed n times per day or as soon as a clinical-chemical parameter is updated. This allows for a quick and adequate reaction to both a deterioration or an improvement of the kidney function and to changes in the serum potassium level. Monitoring is therefore continuous and transmural. Obviously, the Clinical Rules are also reapplied as soon as the treatment, the medication, is adjusted.