{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T13:58:09Z","timestamp":1785592689098,"version":"3.56.0"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Limited evidence exists on the long\u2010term impact of Clinical Decision Support Systems (CDSS) on potassium safety in middle\u2010income countries, with most studies focusing on short\u2010term outcomes in resource\u2010rich settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>This study evaluates the long\u2010term effectiveness of a CDSS in reducing potassium\u2010related adverse events in a Brazilian tertiary\u2010care hospital from 2006 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study analysed all potassium\u2010containing prescriptions (oral and intravenous) at a Brazilian tertiary\u2010care teaching hospital. The study compared the pre\u2010implementation (2006\u20132014) and post\u2010implementation (2014\u20132023) phases of a CDSS that monitors and blocks prescriptions exceeding predefined safety limits for potassium concentration, infusion rate, and daily dose. Near misses were retrospectively identified by applying the same CDSS\u2010defined rules to completed prescriptions\u2014both before and after CDSS implementation. Trends in adverse events and blocked prescription attempts were analysed using Prais\u2010Winsten regression. Data were obtained directly from hospital databases, without coding or transformation. The study adhered to the RECORD statement and received ethical approval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 9,308 drug\u2010related adverse events recorded between 2013 and 2023, 64 (0.7%) involved potassium salts. Despite an increase in overall drug\u2010related events (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), the proportion involving potassium decreased from 2.8% in 2013% to 0.2% in 2023 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). After CDSS implementation, 90,741 potassium prescriptions were submitted, of which 38,961 (42.9%) triggered CDSS blocked attempts, showing a consistent upward trend (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u200920.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Most blocked attempts were due to violations of intravenous concentration (60%) and infusion rate (18%) limits. Near\u2010miss prescriptions remained proportionally high [median 27.4% (IQR: 17.5\u201332.2)] throughout the post\u2010CDSS phase.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates the long\u2010term effectiveness of a potassium\u2010specific CDSS in reducing adverse drug events in a middle\u2010income setting. However, persistent increases in blocked attempts and near misses suggest potential issues related to alert fatigue, overreliance on CDSS, and override practices, highlighting the need for ongoing system refinement and staff training.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70505","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T18:55:51Z","timestamp":1781808951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Impact of a Clinical Decision Support System on Potassium Prescription Safety in a Brazilian Tertiary\u2010Care Hospital: A Retrospective Observational Study (2006\u20132023)"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1298-8557","authenticated-orcid":false,"given":"Gustavo Santos Paiva Laender","family":"Moura","sequence":"first","affiliation":[{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6499-4452","authenticated-orcid":false,"given":"Allana Campos","family":"Alves","sequence":"additional","affiliation":[{"name":"Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7124-9263","authenticated-orcid":false,"given":"Fernando","family":"F\u00e1vero","sequence":"additional","affiliation":[{"name":"Centro de Informa\u00e7\u00f5es e An\u00e1lises Hospital das Cl\u00ednicas de Ribeir\u00e3o Preto Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0700-6339","authenticated-orcid":false,"given":"Lucas","family":"Chaves","sequence":"additional","affiliation":[{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2689-6242","authenticated-orcid":false,"given":"Ajith Kumar","family":"Sankarankutty","sequence":"additional","affiliation":[{"name":"Departamento de Anatomia e Cirurgia, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3491-3396","authenticated-orcid":false,"given":"Eduardo Barbosa","family":"Coelho","sequence":"additional","affiliation":[{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2645-0432","authenticated-orcid":false,"given":"Julieta Mieko","family":"Ueta","sequence":"additional","affiliation":[{"name":"Departamento de Ci\u00eancias Farmac\u00eauticas, Faculdade de Ci\u00eancias Farmac\u00eauticas de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5242-329X","authenticated-orcid":false,"given":"Ant\u00f4nio","family":"Pazin\u2010Filho","sequence":"additional","affiliation":[{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5743-0325","authenticated-orcid":false,"given":"Fabio","family":"Carmona","sequence":"additional","affiliation":[{"name":"Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeir\u00e3o Preto Universidade de S\u00e3o Paulo Ribeir\u00e3o Preto Sao Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Medication Without Harm \u2010 Global Patient Safety Challenge on Medication Safety","author":"World Health Organization","year":"2017"},{"key":"e_1_2_13_3_1","volume-title":"To Err Is Human","author":"Institute of Medicine (US) Committee on Quality of Health Care in America","year":"2000"},{"issue":"1","key":"e_1_2_13_4_1","first-page":"1","article-title":"ISMP List of High\u2010Alert Medications in Acute Care Settings","volume":"29","author":"Institute for Safe Medication Practices","year":"2024","journal-title":"ISMP Medication Safety Alert! 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