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The Design of an Electronic Medical Record Based Clinical Decision Support System in a Large Healthcare System to Improve Antibiotic Safety Using a Validated Risk Score
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A6826 - The Design of an Electronic Medical Record Based Clinical Decision Support System in a Large Healthcare System to Improve Antibiotic Safety Using a Validated Risk Score
Author Block: C. Heise, T. Gallo, S. Curry, R. Woosley; University of Arizona College of Medicine Phoenix, Phoenix, AZ, United States.
RATIONALE Clinical decision support systems use innovative software incorporated into electronic medical records to augment the awareness and expert knowledge of clinicians by providing pertinent and timely information at the point of care. A number of antibiotics are among the medications that prolong the QT interval by blocking the cardiac hERG potassium channel, which increases the risk of a potentially lethal cardiac arrhythmia, torsades de pointes. Based on recent studies, over 15,000 patients a year in the US and Europe are estimated to die from taking non-cardiac QT prolonging medication. While past alerts have statistically improved prescribing of QT prolonging drugs, 77-80% of the alerts were ignored and overridden by prescribers, limiting the clinical impact. Alert fatigue is a real issue. A decision support system should provide clear, logical and simple messages to the clinician to minimize unnecessary work and assist in the optimal selection of antibiotics, discontinuing high risk medications, electrolyte replacement, and the potential value of ECG monitoring. METHODS A clinically validated risk score designed by Tisdale et al was used to quantify risk for drug-induced QT prolongation. Risk scores were collected via a Cerner Discern tool over a 5-month period to determine an appropriate cut-off point for a new clinician advisory. RESULTS During a 5-month period, 128,427 patients were prescribed an antibiotic on the Crediblemeds Known Risk list. 5266 of these were prescribed in the ICU. In the ICU population, a risk score of 12 or above was found to correlate with those patients in the highest 5% of risk for QT prolongation, and was chosen as a threshold for an advisory alert firing. CONCLUSIONS Patients with the highest risk for drug induced cardiac toxicity in the ICU population can be identified by decision support tools and targeted for intervention. This advisory is now in effect at ICUs across our healthcare system.
Author Block: C. Heise, T. Gallo, S. Curry, R. Woosley; University of Arizona College of Medicine Phoenix, Phoenix, AZ, United States.
RATIONALE Clinical decision support systems use innovative software incorporated into electronic medical records to augment the awareness and expert knowledge of clinicians by providing pertinent and timely information at the point of care. A number of antibiotics are among the medications that prolong the QT interval by blocking the cardiac hERG potassium channel, which increases the risk of a potentially lethal cardiac arrhythmia, torsades de pointes. Based on recent studies, over 15,000 patients a year in the US and Europe are estimated to die from taking non-cardiac QT prolonging medication. While past alerts have statistically improved prescribing of QT prolonging drugs, 77-80% of the alerts were ignored and overridden by prescribers, limiting the clinical impact. Alert fatigue is a real issue. A decision support system should provide clear, logical and simple messages to the clinician to minimize unnecessary work and assist in the optimal selection of antibiotics, discontinuing high risk medications, electrolyte replacement, and the potential value of ECG monitoring. METHODS A clinically validated risk score designed by Tisdale et al was used to quantify risk for drug-induced QT prolongation. Risk scores were collected via a Cerner Discern tool over a 5-month period to determine an appropriate cut-off point for a new clinician advisory. RESULTS During a 5-month period, 128,427 patients were prescribed an antibiotic on the Crediblemeds Known Risk list. 5266 of these were prescribed in the ICU. In the ICU population, a risk score of 12 or above was found to correlate with those patients in the highest 5% of risk for QT prolongation, and was chosen as a threshold for an advisory alert firing. CONCLUSIONS Patients with the highest risk for drug induced cardiac toxicity in the ICU population can be identified by decision support tools and targeted for intervention. This advisory is now in effect at ICUs across our healthcare system.
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