Delivering useful clinical decision support to providers who are ordering high risk drugs for high risk patients is imperative for safe pharmacotherapy. This paper presents a focused electronic clinical decision support intervention designed to decrease the risk of corrected QT interval (QTc) related adverse drug events in a high risk patient population. Results showed that a customized alert can both decrease the number of alerts sent to providers while still improving the safety of prescribing practices for intravenous haloperidol. The alert leveraged components of the electronic health record to significantly decrease the rate of inappropriate prescription of intravenous haloperidol in patients with QTc >500 ms from 50% to 14%. The results also suggest providers may abandon the appropriate prescription of a medication in response to an alert. The findings support the necessity of careful targeting of electronic alerts and monitoring for unintended consequences when implementing these types of electronic alerts.
Hospitalized patients have a high prevalence of prolonged QTc and are a high-risk population for Torsades de Pointes (TdP). One modifiable risk factor for TdP is the use of QT prolonging drugs. Electronically alerting providers who are ordering QT prolonging drugs in at-risk patients may help to achieve safer prescribing practices. Our previous study decreased inappropriate prescription of IV haloperidol by 36% using a targeted "smart" electronic alert. We wanted to assess an approach to expanding this type of electronic alert to commonly used QT prolonging medications and evaluate how this would affect prescribing practice. This retrospective cohort study evaluated the impact of these alerts for 12 frequently prescribed high-risk medications across a major health system. Between October 2016 and June 2017, a total of 6453 alerts fired and resulted in 3020 (46.8%) orders being cancelled by the provider. Our focused electronic alert significantly decreased prescribing of QT prolonging medications in high-risk patients.
Introduction: Kidney disease is a major worldwide public health problem. An increased risk for adverse drug events is associated with drug dosing errors in hospitalized patients with renal impairment. A pharmacist-driven renal protocol may improve dosing compliance by allowing pharmacists to monitor renal function and adjust drug doses as needed.Objectives: To evaluate the utilization and financial impact of a pharmacist-driven renal dosing protocol.Methods: This was a retrospective cohort study of patients admitted to an academic medical center from 1 April 2017 to 30 May 2017 who had drug(s) from the protocol dose adjusted by a pharmacist. Outcomes of interest included protocol use frequency, patient characteristics, type of dose adjustments, and when adjustments were made. Two subgroup analyses were performed to: (1) determine cost savings of the seven most adjusted drugs and (2) determine if any missed opportunities for dose adjustments for cefepime.Results: A total of 422 dosage adjustments, performed on 317 patients, were included. The mean age of the patients was 63 years with 51.2% female. The majority (62.8%) had no history of renal dysfunction, 22.4% had chronic kidney disease, 14.8% had end-stage renal disease, and 25.3% had acute kidney injury on admission.Most dose adjustments (73.5%) were dose decreases, while 24.4% were dose increases. The seven most commonly adjusted drugs contributed to a cost savings of approximately $3919.87 per duration of therapy which extrapolates to an annual cost savings of $23 519.22. Of all the cefepime orders reviewed over a 7-day period, 84% were dosed correctly, 9% needed dose adjustments that could have been made sooner, and 7% had incorrect dose based on renal function.Conclusion: This analysis demonstrates that implementation of a pharmacist-driven renal dose adjustment protocol was consistently utilized at our institution and resulted in cost savings.
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