Background: Drugs are an important part of treating diseases but can also come with its risks. To reduce the risks, a system assisted pharmaceutical validation (SAPVAL) is being developed at Uppsala University Hospital. This will include the generation of alerts regarding different risks, sent to a clinical pharmacist who assesses whether the alerts should be forwarded to a physician or not. One of the risks included is QT prolongation, a relatively uncommon condition which however can result in sudden cardiac death. Aim: The aim was to map the management and the consequences of QT-related risk prescriptions and to determine the clinical relevance of QT-related alerts. Method: A retrospective cross-sectional study was performed at Uppsala University Hospital. It included the review of patients´ electronic health records (EHR) and determination of risk periods. The clinical relevance of the alerts was assessed by a physician and a developed flowchart. Results: 65 patients (age=71 ± 15 years, 54% women), and their 85 QT-related alerts were included, with a median risk period of 145 days. Within the risk period, 46 patients had an ECG taken with 35% having one or more prolonged QTc ≥ 480 ms. The risk of QT prolongation had been noticed or mitigated for 23% of the 65 patients. 89% of the alerts were concluded to be clinically relevant. Conclusion: The management and documentation of QT-related risks could be improved. It is also important to further study QT-related risk factors to better assess which patients are at the highest risk.

Background: A closed-loop medication system is planned to be implemented at Uppsala University Hospital. Thus, an advanced pharmaceutical validation system called System-Assisted Pharmaceutical VALidation (SAPVAL) is being developed, which aims to identify and manage risk prescriptions, hence reducing potential adverse drug events (ADEs). The system is based on clinical rules that generate an alert due to a "risk score”. As part of SAPVAL, this study focuses on alerts related to an increased risk of bleeding. Aim: This study aims to investigate, gain an enhanced understanding, and determine the clinical significance of alerts generated by one of the clinical rules (rule 2- risk of bleeding) that was developed within SAPVAL. Methods: A cross-sectional retrospective study where alerts 100 from randomly selected patients, with a previously identified risk of bleeding, were investigated in regard to the risk period for potential/true ADEs, undertaken mitigation measures and clinical significance. This was done by accessing the patients’ electronic health records. Results: The risk period for potential ADEs was 29 days. In total, 35 ADEs were identified, with anemia as the most common symptom. Mitigation measures were undertaken for 55 patients, of which the most common were prescription of a proton pump inhibitor and blood transfusions. The clinical evaluation showed that 66% of the 103 included alerts were deemed clinically insignificant. Conclusion: Most alerts were deemed clinically insignificant. This in turn, emphasizes the importance of a system like SAPVAL, where insignificant alerts are filtered away by pharmacists before reaching the physicians, thus reducing problems related to alert fatigue.