Title: Implementing a Pharmacy Clinical Decision Support Council for a 54Hospital health-system.
Authors: Sabrina Desmond, Pharm.D.; Fei Wang, Pharm.D.; Craig MacDonald, Pharm.D.
Objective: To describe the creation and maintence of a clinical decision support oversight group to manage alerts within a multi-state health system.
Self Assessment Question: True or False: The only purpose of a clinical decision support council is to eliminate as many alerts as possible to reduce alert fatigue.
Background: Pharmacy-driven clinical decision support (CDS) is a critical element for optimizing medication safety and therapeutic outcomes in inpatient hospital systems. Pharmacy teams often manage an extensive array of drug-related alerts that can range from formulary and dosing recommendations to drug interactions and therapeutic duplications. Without focused oversight, these alerts can become overwhelming and lead to alert fatigue which could compromise the quality of patient care. A pharmacy-specific CDS Council can address these challenges by standardizing alert strategies, prioritizing clinically relevant notifications, and driving evidence-based enhancements to medication-related workflows.
Methods: Constructing an advisory group to oversee drug-related alerts required several steps:
- Establishing a workflow for alert review submissions
- Creating specialized workgroups that could provide insight for alert reviews
- Construct a voting structure that allows for diverse assessment and input
Items are entered into the CDS review process by inputting a request into a ticket management platform. After submission, items are reviewed by a workgroup comprised of electronic health record (EHR) analysts and pharmacy informatics experts to evaluate the request and propose solutions for consideration. Following that initial review, solutions are discussed and voted on independently by a medication safety workgroup and a clinical workgroup. Each of these workgroups have at least one representative from each of the eight regions within the hospital system. Finally, solutions and voting results are presented to a final council that includes leaders in clinical, medication safety, EHR, and informatics specialties. All results are discussed, and final actions are determined.
To evaluate the interventions made by this CDS council, requests have been categorized into 4 groups: alert deactivation, alert activation, creation of a custom alert, and no action taken. A secondary analysis was performed to better understand the reasons for taking no action. Therefore, the group "no action taken" was further subcategorized into one of the following: alert is appropriate, alert is not indicated, functionality not available, or exists in current state.
Results: A total of 59 items were tracked from August 1st, 2024 - March 31, 2025.The number of items reviewed were categorized into the 4 groups as follows:
- Alert deactivation: 4 items
- Alert activation: 11 items
- Creation of custom alert: 12 items
- No action taken: 32 items
Since there were 32 items that were categorized as "no action taken," these items were further subcategorized as follows:
- Alert is appropriate: 18items
- Alert is not indicated: 5 items
- Functionality not available: 5 items
- Exists in current state: 4 items
Conclusion: A structured workflow is needed in order to perform a systematic review and comprehensive assessment for CDS enhancements within a health system. By gathering insight from diverse specialties and system-wide representatives, balanced adjustments can be made to alert settings. These adjustments potentially lead to management of alert fatigue and other limitations experienced with CDS tools. Further investigation is needed to assess the overall impact that is made when adjusting alert settings. Additionally, further optimization and expansion of the CDS Council process can allow for proactive investigation of potential alert adjustments as well as an assessment of other CDS components beyond alert settings.
