Contact email

dbates@bwh.harvard.edu

Overview

This retrospective evaluation studies renal medication clinical decision support (CDS) alerts in an inpatient setting at a large academic medical center demonstrating that nearly all renal medication dose alert triggers were considered inappropriate.

Department

Medicine

Division

General Medicine

Collaborators

Diane Seger Pharm D., RPh
Mary Amato Pharm D., RPh
Sonam N Shah Pharm D., RPh
David W. Bates MD

Status/Stage of Development

Ongoing program

Measurement

The primary outcome was appropriateness of the alert trigger and overrides assessed by two reviewers. Secondary outcomes included incidence of ADEs that resulted from the overridden alert based on documentation in the patients' medical record.

Results

-Of 1352 alerts considered appropriate for evaluation, 83 (6.1%) were considered appropriate and 1269 (93.8%) were considered inappropriate.
-Override rate for renal CDS was 100% with 1291 (95.6%) of overrides considered appropriate and 61 (4.4%) considered inappropriate.
-The following medications were associated with appropriate overrides: KCL (51.3%), chlorothiazide (28.6%), aspirin (21.0%), cholecalciferol (19.3%), magnesium oxide (11.1%), and ergocalciferol (10.6%)
-The following medications were responsible for inappropriate overrides: duloxetine (16.7%), phenazopyridine (11.7%), fenofibrate (6.67%), cetirizine (6.67%), and alendronate (5.0%)
-Adverse drug events associated with inappropriate overrides were low (n=2).

Additional details

- Increasing the specificity and clinical significance of displayed alerts, while decreasing the number of insignificant alerts may decrease alert fatigue
- Considerations to improve accuracy of alerts include differentiation of the dose prescribed, whether the patient is currently receiving hemodialysis, and patient specific factors such as ordered monitoring lab values.

Sources

Sonam N. Shah, Diane L. Seger, Mary Amato, David W. Bates. Retrospective Evaluation of Renal Medication Related Clinical Decision Support (CDS) Alerts and Overrides in the Inpatient Setting Post Implementation of a Commercial EHR [abstract]. In: SGIM Annual Meeting 2019.;May 8-May 11; Washington D.C.