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Initial Impact of a Clinical Decision Support System to Improve the Safety of QT Prolonging Antibiotics
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A6822 - Initial Impact of a Clinical Decision Support System to Improve the Safety of QT Prolonging Antibiotics
Author Block: C. Heise, T. Gallo, R. A. Raschke, 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 new clinical advisory tool was implemented in critical care units across a major health system in the Cerner electronic medical record. After the first 100 alerts were issued, clinician ordering data were queried in the immediate time surrounding the alert. RESULTS The first 100 patients who received an advisory for QT prolongation risk were on an average of 3.19 medications on the Crediblemeds.org known risk list. Within one hour of this advisory, 14% of these medications were discontinued. When the advisory fired, 52% of these patients had a 12 lead ECG in the last 24 hours. 17% appeared to have an ECG ordered at the time of the alert. CONCLUSIONS Clinical decision support systems can advise clinicians to take appropriate steps to mitigate risk of QT prolongation. We will study if these advisories change patient outcomes.
Author Block: C. Heise, T. Gallo, R. A. Raschke, 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 new clinical advisory tool was implemented in critical care units across a major health system in the Cerner electronic medical record. After the first 100 alerts were issued, clinician ordering data were queried in the immediate time surrounding the alert. RESULTS The first 100 patients who received an advisory for QT prolongation risk were on an average of 3.19 medications on the Crediblemeds.org known risk list. Within one hour of this advisory, 14% of these medications were discontinued. When the advisory fired, 52% of these patients had a 12 lead ECG in the last 24 hours. 17% appeared to have an ECG ordered at the time of the alert. CONCLUSIONS Clinical decision support systems can advise clinicians to take appropriate steps to mitigate risk of QT prolongation. We will study if these advisories change patient outcomes.
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