Abstract：
BACKGROUND: Pharmaceutical decision support systems (PDSSs) use reasoning software to match patient data to modelled situations likely to cause drug-related problems (DRPs) or adverse drug events. To aid decision-making, modelled situations must be linked to well-defined systemic clinical risks.
OBJECTIVE: To obtain expert consensus on the level of clinical risk for patients associated with each modelled situation that could be addressed using a PDSS.
METHODS: A two-round e-Delphi survey was conducted from February to April 2022, involving 20 experts from four French-speaking countries. Participants had to rate modelled situations on two five-point Likert scales, assessing the likelihood of clinical consequences and their severity. The degree of consensus was determined as the proportion of participants providing risk scores in line with the median. The combined median scores for likelihood and severity provided the level of risk according to the Clinical Risk Situation for Patients (CRiSP) scale, formalized via validated tools.
RESULTS: The expert panel achieved consensus (≥ 75% agreement) on 48 out of 52 modelled clinical situations. Among these, 45 were categorized as high or extreme risk. The most common DRP identified was overdosing, accounting for 22% of cases. Furthermore, DRPs involving cardiovascular, psychiatric, and endocrinological drug classes were prevalent, constituting 45, 13, and 9% of cases, respectively.
CONCLUSIONS: Through consensus, our study identified 45 modelled clinical situations associated with high or extreme risks. This study highlights the interest of using PDSSs to prevent harm in patients and, on a large scale, document the impact of the pharmacist in preventing, intercepting and managing iatrogenic drug risk.
OBJECTIVE: To obtain expert consensus on the level of clinical risk for patients associated with each modelled situation that could be addressed using a PDSS.
METHODS: A two-round e-Delphi survey was conducted from February to April 2022, involving 20 experts from four French-speaking countries. Participants had to rate modelled situations on two five-point Likert scales, assessing the likelihood of clinical consequences and their severity. The degree of consensus was determined as the proportion of participants providing risk scores in line with the median. The combined median scores for likelihood and severity provided the level of risk according to the Clinical Risk Situation for Patients (CRiSP) scale, formalized via validated tools.
RESULTS: The expert panel achieved consensus (≥ 75% agreement) on 48 out of 52 modelled clinical situations. Among these, 45 were categorized as high or extreme risk. The most common DRP identified was overdosing, accounting for 22% of cases. Furthermore, DRPs involving cardiovascular, psychiatric, and endocrinological drug classes were prevalent, constituting 45, 13, and 9% of cases, respectively.
CONCLUSIONS: Through consensus, our study identified 45 modelled clinical situations associated with high or extreme risks. This study highlights the interest of using PDSSs to prevent harm in patients and, on a large scale, document the impact of the pharmacist in preventing, intercepting and managing iatrogenic drug risk.
摘要：
背景：制药决策支持系统（PDSS）使用推理软件将患者数据与可能导致药物相关问题（DRP）或不良药物事件的建模情况进行匹配。为了帮助决策，建模的情况必须与明确定义的系统性临床风险相关联。
目的：就可以使用PDSS解决的与每种模型情况相关的患者临床风险水平获得专家共识。
方法：2022年2月至4月进行了两轮e-Delphi调查，涉及来自四个法语国家的20名专家。参与者必须在两个五点李克特量表上对建模的情况进行评分，评估临床后果的可能性及其严重程度。共识程度确定为提供与中位数一致的风险评分的参与者比例。可能性和严重程度的综合中位数评分提供了根据患者临床风险状况（CRiSP）量表的风险水平，通过验证的工具形式化。
结果：专家小组就52种模拟的临床情况中的48种达成了共识（≥75％的共识）。其中,45人被归类为高风险或极端风险。最常见的DRP是过量用药，占22％的病例。此外，涉及心血管的DRP，精神病学,内分泌药物类别很普遍，占病例的45%、13%和9%，分别。
结论：通过协商一致，我们的研究确定了45例与高风险或极端风险相关的模拟临床情况.这项研究强调了使用PDSS预防患者伤害的兴趣，大规模地,记录药剂师在预防方面的影响，拦截和管理医源性药物风险。
目的：就可以使用PDSS解决的与每种模型情况相关的患者临床风险水平获得专家共识。
方法：2022年2月至4月进行了两轮e-Delphi调查，涉及来自四个法语国家的20名专家。参与者必须在两个五点李克特量表上对建模的情况进行评分，评估临床后果的可能性及其严重程度。共识程度确定为提供与中位数一致的风险评分的参与者比例。可能性和严重程度的综合中位数评分提供了根据患者临床风险状况（CRiSP）量表的风险水平，通过验证的工具形式化。
结果：专家小组就52种模拟的临床情况中的48种达成了共识（≥75％的共识）。其中,45人被归类为高风险或极端风险。最常见的DRP是过量用药，占22％的病例。此外，涉及心血管的DRP，精神病学,内分泌药物类别很普遍，占病例的45%、13%和9%，分别。
结论：通过协商一致，我们的研究确定了45例与高风险或极端风险相关的模拟临床情况.这项研究强调了使用PDSS预防患者伤害的兴趣，大规模地,记录药剂师在预防方面的影响，拦截和管理医源性药物风险。
