Table 6

Signal with Computerised Physician Order Entry/Clinical Decision Support Systems (CPOE/CDSS) or clinical rule but no medication error in medication review

Signal	Reasoning
CPOE/CDSS overdose for example:
Furosemide intravenous 40 mg once daily Amoxicillin intravenous 1 g four times daily Omeprazole intravenous 40 mg twice daily	All these doses are well accepted in a clinical setting in a more severely ill patient population and deviate from the maximum recommended doses in a community setting for which the medication control database was developed
CPOE/CDSS drug–drug interaction—for example:
non-steroid anti-inflammatory drugs and prednisolone	Due to the increased risk of gastrointestinal irritation this combination should be avoided or gastric protection should be provided. Where a proton pump inhibitor was administered simultaneously, this interaction was not considered a medication error, as the appropriate action had been taken.
Clinical rules for example number:
12. Use of opioid and no prescription for laxative 10. Digoxin rule (table 5) 1. to 10. impaired renal function and potential for drug overdose	12. Patient receives only a single dose of opiate (eg, morphine intravenous stat) or has diarrhoea when the signal is generated10. For example patient has low potassium levels but gets potassium suppletion1. to 10. Dose has been adapted in line with recommendations of the level of renal impairment