Development of a liver function–based dose adjustment tool integrated into the electronic prescribing system at Hai Phong International General Hospital

Abstract

Background: Patients with hepatic impairment are at high risk of adverse drug events if doses are not properly adjusted according to liver function. However, systematic implementation of dose adjustment based on the Child-Pugh classification remains limited in clinical practice at many healthcare facilities. Objective: To evaluate the effectiveness of an integrated alert tool in the electronic prescribing system in reducing inappropriate dose prescriptions among hospitalized patients with hepatic impairment. Methods: This was a pre–post interventional study without a control group, conducted at Hai Phong International General Hospital from January to June 2025. Eligible prescriptions were inpatient medication orders containing at least one active substance requiring dose adjustment based on liver function. Prescriptions were written by physicians in the Internal Medicine, Emergency and Intensive Care, and Gastroenterology departments. The electronic prescribing system was integrated with a clinical decision support tool that provided dose adjustment alerts based on ICD-10 diagnostic codes and prescribed active substances. A total of 820 patients were included in the analysis, comprising 400 pre-intervention and 420 post-intervention cases. Data were analyzed using R software, with appropriate statistical tests (p < 0.05 considered significant). Results: The rate of inappropriate dosing significantly decreased after the intervention (from 24.0% to 9.0%, p < 0.001), with the most marked improvement observed in patients classified as Child-Pugh B. The physician alert acceptance rate reached 80.0%, highest among anticoagulants and antibiotics. There were no statistically significant differences in baseline characteristics between the two groups. Conclusion: The implementation of a liver function–based dose adjustment alert tool significantly improved prescribing safety and was well accepted by clinicians. Broader application and further research are needed to assess long-term clinical outcomes.