A 67-year-old male with newly diagnosed atrial fibrillation is prescribed dabigatran 150 mg twice daily in the outpatient clinic. The electronic health record contains recent laboratory values showing a creatinine of 2.1 mg/dL and an estimated glomerular filtration rate (eGFR) of 28 mL/min/1.73m². The prescriber did not review these values before ordering. The patient presents to the emergency department 2 weeks later with melena and a hemoglobin of 7.2 g/dL. Investigation reveals supratherapeutic dabigatran levels due to renal accumulation. The EHR system had the renal function data available but did not generate an alert or contraindication warning at the time of prescribing. Which of the following best describes the primary system failure that contributed to this adverse event?

1. A)Failure of the pharmacokinetics education provided during medical school training to emphasize drug metabolism
2. B)Inadequate regulation of direct oral anticoagulant marketing practices by the FDA
3. C)Insufficient patient adherence to anticoagulation monitoring laboratory protocols
4. D)Absence of a mandatory clinical pharmacist verification step in the outpatient prescribing workflow
5. E)Failure of the clinical decision support system to provide evidence-based prescribing alerts based on available patient dataGABARITO