1
|
Bauer J, Busse M, Kopetzky T, Seggewies C, Fromm MF, Dörje F. Interprofessional Evaluation of a Medication Clinical Decision Support System Prior to Implementation. Appl Clin Inform 2024; 15:637-649. [PMID: 39084615 PMCID: PMC11290949 DOI: 10.1055/s-0044-1787184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/01/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Computerized physician order entry (CPOE) and clinical decision support systems (CDSS) are widespread due to increasing digitalization of hospitals. They can be associated with reduced medication errors and improved patient safety, but also with well-known risks (e.g., overalerting, nonadoption). OBJECTIVES Therefore, we aimed to evaluate a commonly used CDSS containing Medication-Safety-Validators (e.g., drug-drug interactions), which can be locally activated or deactivated, to identify limitations and thereby potentially optimize the use of the CDSS in clinical routine. METHODS Within the implementation process of Meona (commercial CPOE/CDSS) at a German University hospital, we conducted an interprofessional evaluation of the CDSS and its included Medication-Safety-Validators following a defined algorithm: (1) general evaluation, (2) systematic technical and content-related validation, (3) decision of activation or deactivation, and possibly (4) choosing the activation mode (interruptive or passive). We completed the in-depth evaluation for exemplarily chosen Medication-Safety-Validators. Moreover, we performed a survey among 12 German University hospitals using Meona to compare their configurations. RESULTS Based on the evaluation, we deactivated 3 of 10 Medication-Safety-Validators due to technical or content-related limitations. For the seven activated Medication-Safety-Validators, we chose the interruptive option ["PUSH-(&PULL)-modus"] four times (4/7), and a new, on-demand option ["only-PULL-modus"] three times (3/7). The site-specific configuration (activation or deactivation) differed across all participating hospitals in the survey and led to varying medication safety alerts for identical patient cases. CONCLUSION An interprofessional evaluation of CPOE and CDSS prior to implementation in clinical routine is crucial to detect limitations. This can contribute to a sustainable utilization and thereby possibly increase medication safety.
Collapse
Affiliation(s)
- Jacqueline Bauer
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marika Busse
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tanja Kopetzky
- Medical Center for Information and Communication Technology (MIK), Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christof Seggewies
- Medical Center for Information and Communication Technology (MIK), Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin F. Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- FAU NeW—Research Center New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Dörje
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- FAU NeW—Research Center New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
2
|
Felisberto M, Lima GDS, Celuppi IC, Fantonelli MDS, Zanotto WL, Dias de Oliveira JM, Mohr ETB, Dos Santos RA, Scandolara DH, Cunha CL, Hammes JF, da Rosa JS, Demarchi IG, Wazlawick RS, Dalmarco EM. Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis. Health Informatics J 2024; 30:14604582241263242. [PMID: 38899788 DOI: 10.1177/14604582241263242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Primary studies have demonstrated that despite being useful, most of the drug-drug interaction (DDI) alerts generated by clinical decision support systems are overridden by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians. The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases. Blinded reviewers screened 1873 records and 86 full studies, and 16 articles were included for analysis. The overall prevalence of alert generated by CDSS was 13% (CI95% 5-24%, p-value <0.0001, I^2 = 100%), and the overall prevalence of alert override by physicians was 90% (CI95% 85-95%, p-value <0.0001, I^2 = 100%). This systematic review and meta-analysis presents a high rate of alert overrides, even after CDSS adjustments that significantly reduced the number of alerts. After analyzing the articles included in this review, it was clear that the CDSS alerts physicians about potential DDI should be developed with a focus on the user experience, thus increasing their confidence and satisfaction, which may increase patient clinical safety.
Collapse
Affiliation(s)
- Mariano Felisberto
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Geovana Dos Santos Lima
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Nursing, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Ianka Cristina Celuppi
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Nursing, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Wagner Luiz Zanotto
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Júlia Meller Dias de Oliveira
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
- Graduate Program in Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eduarda Talita Bramorski Mohr
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Ranieri Alves Dos Santos
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Célio Luiz Cunha
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Jades Fernando Hammes
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Júlia Salvan da Rosa
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Raul Sidnei Wazlawick
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eduardo Monguilhott Dalmarco
- Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
3
|
Kardas P, Mair A, Stewart D, Lewek P. Optimizing polypharmacy management in the elderly: a comprehensive European benchmarking survey and the development of an innovative online benchmarking application. Front Pharmacol 2023; 14:1254912. [PMID: 37915419 PMCID: PMC10616468 DOI: 10.3389/fphar.2023.1254912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
Background: Polypharmacy, defined as the simultaneous use of multiple medications by a patient, is a worldwide problem of rising prevalence. Paving the way for drug interactions, adverse drug reactions and non-adherence, it leads to negative health outcomes, increased use of healthcare services and rising costs. Since it is closely related to multimorbidity, it peaks in older adults. So far, not many polypharmacy management programs in the elderly have been introduced in practice. However, due to the rapid ageing of European societies, there is an urgent need to implement them more widely. Objective: The aim of this study was to benchmark polypharmacy management programs in the elderly available in Europe and creating a dedicated benchmarking application. Methods: It was a cross-sectional study based on an online survey targeting healthcare professionals and other stakeholders across European countries. Data collected in the survey were reused to design an online benchmarking application. Results: As many as 911 respondents from all but two EU countries took part in this study. Out of the survey participants, 496 (54.4%) reported availability of various activities or formal programs targeting polypharmacy in the elderly that were known to them. These programs had multiple goals, of which improved patient safety was indicated as the most common objective (65.1% of the cases). The most typical settings for such programs was primary care (49.4%), with pharmacists and primary care doctors being indicated most often as those providing the programs (61.7% and 35.5% of cases, respectively). Vast majority of programs applied diverse forms of drug reviews. The identified programs were assessed against four predefined dimensions of effectiveness, applicability, scalability and cost-effectiveness. The lowest scores were obtained within the last of these categories, due to unavailability of relevant data. Based on the survey results, a benchmarking application was constructed. It allows for comparing an individual polypharmacy management program targeting the elderly against the other ones, and particularly, against the national and European context. Conclusion: By providing strong evidence, the findings of this study, coupled with the benchmarking application, can prove valuable in aiding clinicians and policymakers in the implementation and expansion of polypharmacy management programs for the elderly.
Collapse
Affiliation(s)
- Przemysław Kardas
- Department of Family Medicine, Medication Adherence Research Centre, Medical University of Lodz, Lodz, Poland
| | - Alpana Mair
- Effective Prescribing and Therapeutics Division, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Paweł Lewek
- Department of Family Medicine, Medication Adherence Research Centre, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
4
|
Karajizadeh M, Zand F, Vazin A, Saeidnia HR, Lund BD, Tummuru SP, Sharifian R. Design, development, implementation, and evaluation of a severe drug-drug interaction alert system in the ICU: An analysis of acceptance and override rates. Int J Med Inform 2023; 177:105135. [PMID: 37406570 DOI: 10.1016/j.ijmedinf.2023.105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The override rate of Drug-Drug Interaction Alerts (DDIA) in Intensive Care Units (ICUs) is very high. Therefore, this study aimed to design, develop, implement, and evaluate a severe Drug-Drug Alert System (DDIAS) in a system of ICUs and measure the override rate of this system. METHODS This is a cross-sectional study that details the design, development, implementation, and evaluation of a DDIAS for severe interactions into a Computerized Provider Order Entry (CPOE) system in the ICUs of Nemazee general teaching hospitals in 2021. The patients exposed to the volume of DDIAS, acceptance and overridden of DDIAS, and usability of DDIAS have been collected. The study was approved by the local Institutional Review Board (IRB) and; the ethics committee of Shiraz University of Medical Science on date: 2019-11-23 (Approval ID: IR.SUMS.REC.1398.1046). RESULTS The knowledge base of the DDIAS contains 9,809 severe potential drug-drug interactions (pDDIs). A total of 2672 medications were prescribed in the population study. The volume and acceptance rate for the DDIAS were 81 % and 97.5 %, respectively. The override rate was 2.5 %. The mean System Usability Scale (SUS) score of the DDIAS was 75. CONCLUSION This study demonstrates that implementing high-risk DDIAS at the point of prescribing in ICUs improves adherence to alerts. In addition, the usability of the DDIAS was reasonable. Further studies are needed to investigate the establishment of severe DDIAS and measure the prescribers' response to DDIAS on a larger scale.
Collapse
Affiliation(s)
- Mehrdad Karajizadeh
- Shiraz University of Medical, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz, Iran.
| | - Farid Zand
- Shiraz University of Medical Sciences, Anesthesiology and Critical Care Research Center, Shiraz, Iran
| | - Afsaneh Vazin
- Shiraz University of Medical Sciences, Shiraz, Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz, Iran
| | | | - Brady D Lund
- University of North Texas, Department of Information Science, Denton, TX, US
| | - Sai Priya Tummuru
- University of North Texas, Department of Information Science, Denton, TX, US
| | - Roxana Sharifian
- Shiraz University of Medical Sciences, Department of Health Information Management, Health Human Resources Research Center, School of Management & Medical Information Sciences, Shiraz, Iran.
| |
Collapse
|
5
|
Liu Y, Wang J, Gong H, Li C, Wu J, Xia T, Li C, Li S, Chen M. Prevalence and associated factors of drug-drug interactions in elderly outpatients in a tertiary care hospital: a cross-sectional study based on three databases. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:17. [PMID: 36760261 PMCID: PMC9906203 DOI: 10.21037/atm-22-5463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/27/2022] [Indexed: 01/16/2023]
Abstract
Background Drug-drug interactions (DDIs) are factors of adverse drug reactions and are more common in elderly patients. Identifying potential DDIs can prevent the related risks. Fewer studies of potential DDIs in prescribing for elderly patients in outpatient clinics. This study aimed to investigate the prevalence and associated factors with potential DDIs and potentially clinically significant DDIs (csDDIs) among elderly outpatients based on 3 DDIs databases. Methods A cross-sectional study was carried out on outpatients (≥65 years old) of a tertiary care hospital in China between January and March 2022. Patients' prescriptions, including at least 1 systemic drug, were consecutively collected. The potential DDIs were identified by Lexicomp®, Micromedex®, and DDInter. Patient-related clinical parameter recorded at the prescriptions and DDIs with higher risk rating was analyzed. Variables showing association in univariate analysis (P<0.2) were included in logistic regression analysis. Weighted kappa analysis was used to analyze the consistencies of different databases. Results A total of 19,991 elderly outpatients were involved in the study, among whom 21,527 drug combinations including 486 drugs occurred. Lexicomp®, Micromedex®, and DDInter respectively identified 32.22%, 32.93%, and 22.62% of patients have at least one potential DDIs, meanwhile, 9.16%, 14.53%, and 4.56% of patients have at least one potential csDDIs. Under any evaluation criteria, polypharmacy and neurology visits were risk factors for csDDIs. Lexicomp® has the highest coverage rate (87.86%) for drugs. Micromedex® identified the most csDDIs (740 drug combinations). Drugs used in diabetes and psycholeptics were frequently found in the csDDIs of 2 commercial databases. The consistency between Lexicomp® and Micromedex® was moderate (weighted kappa 0.473). DDInter had fair consistencies with the other databases. Conclusions This study showed the prevalence of potential DDIs is high in elderly outpatients and potential csDDIs were prevalent. Considering the relative risk, pre-warning of potential DDIs before outpatient prescribing is necessary. As the consistencies among identification criteria are not good, more research is needed to focus on actual adverse outcomes to promote accurate prevention of csDDIs.
Collapse
Affiliation(s)
- Yue Liu
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China;,Western Theater Command General Hospital of PLA, Chengdu, China
| | - Jin Wang
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| | - Hui Gong
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| | - Chen Li
- Translational Medicine Centre of PLA General Hospital, Beijing, China
| | - Jin Wu
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| | - Tianyi Xia
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| | - Chuntong Li
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| | - Shu Li
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| | - Mengli Chen
- Department of Pharmacy, Medical Supplies Centre of PLA General Hospital, Beijing, China
| |
Collapse
|
6
|
Wasylewicz ATM, van de Burgt BWM, Manten T, Kerskes M, Compagner WN, Korsten EHM, Egberts TCG, Grouls RJE. Contextualized Drug-Drug Interaction Management Improves Clinical Utility Compared With Basic Drug-Drug Interaction Management in Hospitalized Patients. Clin Pharmacol Ther 2022; 112:382-390. [PMID: 35486411 PMCID: PMC9540177 DOI: 10.1002/cpt.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022]
Abstract
Drug–drug interactions (DDIs) frequently trigger adverse drug events or reduced efficacy. Most DDI alerts, however, are overridden because of irrelevance for the specific patient. Basic DDI clinical decision support (CDS) systems offer limited possibilities for decreasing the number of irrelevant DDI alerts without missing relevant ones. Computerized decision tree rules were designed to context‐dependently suppress irrelevant DDI alerts. A crossover study was performed to compare the clinical utility of contextualized and basic DDI management in hospitalized patients. First, a basic DDI‐CDS system was used in clinical practice while contextualized DDI alerts were collected in the background. Next, this process was reversed. All medication orders (MOs) from hospitalized patients with at least one DDI alert were included. The following outcome measures were used to assess clinical utility: positive predictive value (PPV), negative predictive value (NPV), number of pharmacy interventions (PIs)/1,000 MOs, and the median time spent on DDI management/1,000 MOs. During the basic DDI management phase 1,919 MOs/day were included, triggering 220 DDI alerts/1,000 MOs; showing 57 basic DDI alerts/1,000 MOs to pharmacy staff; PPV was 2.8% with 1.6 PIs/1,000 MOs costing 37.2 minutes/1,000 MOs. No DDIs were missed by the contextualized CDS system (NPV 100%). During the contextualized DDI management phase 1,853 MOs/day were included, triggering 244 basic DDI alerts/1,000 MOs, showing 9.6 contextualized DDIs/1,000 MOs to pharmacy staff; PPV was 41.4% (P < 0.01), with 4.0 PIs/1,000 MOs (P < 0.01) and 13.7 minutes/1,000 MOs. The clinical utility of contextualized DDI management exceeds that of basic DDI management.
Collapse
Affiliation(s)
- Arthur T M Wasylewicz
- Department of Healthcare Intelligence, Catharina Hospital, Eindhoven, The Netherlands.,Department of Signal Processing Systems, Faculty of Electronic Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Thomas Manten
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
| | - Marieke Kerskes
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
| | - Wilma N Compagner
- Department of Healthcare Intelligence, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik H M Korsten
- Department of Healthcare Intelligence, Catharina Hospital, Eindhoven, The Netherlands.,Department of Signal Processing Systems, Faculty of Electronic Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Toine C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rene J E Grouls
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
| |
Collapse
|
7
|
Bittmann JA, Haefeli WE, Seidling HM. Modulators Influencing Medication Alert Acceptance: An Explorative Review. Appl Clin Inform 2022; 13:468-485. [PMID: 35981555 PMCID: PMC9388223 DOI: 10.1055/s-0042-1748146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/04/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Clinical decision support systems (CDSSs) use alerts to enhance medication safety and reduce medication error rates. A major challenge of medication alerts is their low acceptance rate, limiting their potential benefit. A structured overview about modulators influencing alert acceptance is lacking. Therefore, we aimed to review and compile qualitative and quantitative modulators of alert acceptance and organize them in a comprehensive model. METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, a literature search in PubMed was started in February 2018 and continued until October 2021. From all included articles, qualitative and quantitative parameters and their impact on alert acceptance were extracted. Related parameters were then grouped into factors, allocated to superordinate determinants, and subsequently further allocated into five categories that were already known to influence alert acceptance. RESULTS Out of 539 articles, 60 were included. A total of 391 single parameters were extracted (e.g., patients' comorbidity) and grouped into 75 factors (e.g., comorbidity), and 25 determinants (e.g., complexity) were consequently assigned to the predefined five categories, i.e., CDSS, care provider, patient, setting, and involved drug. More than half of all factors were qualitatively assessed (n = 21) or quantitatively inconclusive (n = 19). Furthermore, 33 quantitative factors clearly influenced alert acceptance (positive correlation: e.g., alert type, patients' comorbidity; negative correlation: e.g., number of alerts per care provider, moment of alert display in the workflow). Two factors (alert frequency, laboratory value) showed contradictory effects, meaning that acceptance was significantly influenced both positively and negatively by these factors, depending on the study. Interventional studies have been performed for only 12 factors while all other factors were evaluated descriptively. CONCLUSION This review compiles modulators of alert acceptance distinguished by being studied quantitatively or qualitatively and indicates their effect magnitude whenever possible. Additionally, it describes how further research should be designed to comprehensively quantify the effect of alert modulators.
Collapse
Affiliation(s)
- Janina A. Bittmann
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E. Haefeli
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hanna M. Seidling
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
8
|
Stettner S, Adie S, Hanigan S, Thomas M, Pogue K, Zimmerman C. Effect of Replacing Vendor QTc Alerts with a Custom QTc Risk Alert in Inpatients. Appl Clin Inform 2022; 13:19-29. [PMID: 34986493 PMCID: PMC8731239 DOI: 10.1055/s-0041-1740483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of the study is to implement a customized QTc interval clinical decision support (CDS) alert strategy in our electronic health record for hospitalized patients and aimed at providers with the following objectives: minimize QTc prolongation, minimize exposure to QTc prolonging medications, and decrease overall QTc-related alerts. A strategy that was based on the validated QTc risk scoring tool and replacing medication knowledge vendor alerts with custom QTc prolongation alerts was implemented. METHODS This is a retrospective quasi-experimental study with a pre-intervention period (August 2019 to October 2019) and post-intervention period (December 2019 to February 2020). The custom alert was implemented in November 2019. RESULTS In the pre-implementation group, 361 (19.3%) patients developed QTc prolongation, and in the post-implementation group, 357 (19.6%) patients developed QTc prolongation (OR: 1.02, 95% CI: 0.87-1.20, p = 0.81). The odds ratio of an action taken post-implementation compared with pre-implementation was 18.90 (95% CI: 14.03-25.47, p <0. 001). There was also a decrease in total orders for QTc prolonging medications from 7,921 (5.5%) to 7,566 (5.3%) with an odds ratio of 0.96 (95% CI: 0.93-0.99, p = 0.01). CONCLUSION We were able to decrease patient exposure to QTc prolonging medications while not increasing the rate of QTc prolongation as well as improving alert action rate. Additionally, there was a decrease in QTc prolonging medication orders which illustrates the benefit of using a validated risk score with a customized CDS approach compared with a traditional vendor-based strategy. Further research is needed to confirm if an approach implemented at our organization can reduce QTc prolongation rates.
Collapse
Affiliation(s)
- Steven Stettner
- Department of Pharmacy, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
| | - Sarah Adie
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Sarah Hanigan
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Michael Thomas
- Department of Internal Medicine-Cardiology, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Kristen Pogue
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Christopher Zimmerman
- Department of Health Information and Technology Services, Michigan Medicine, Ann Arbor, Michigan, United States,Address for correspondence Christopher Zimmerman, PharmD Health Information and Technology Services, Michigan MedicineSuite 500; 510-05, 777 E. Eisenhower Parkway, Ann Arbor, MI 48108-3273United States
| |
Collapse
|
9
|
Kurczewska-Michalak M, Lewek P, Jankowska-Polańska B, Giardini A, Granata N, Maffoni M, Costa E, Midão L, Kardas P. Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions. Front Pharmacol 2021; 12:734045. [PMID: 34899294 PMCID: PMC8661120 DOI: 10.3389/fphar.2021.734045] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group. Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary. Data sources: Articles published between January 2010-March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults. Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems. Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no "gold standard" is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.
Collapse
Affiliation(s)
| | - P. Lewek
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - B. Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - A. Giardini
- IT Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - N. Granata
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Pavia, Italy
| | - M. Maffoni
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Montescano Institute, Pavia, Italy
| | - E. Costa
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - L. Midão
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - P. Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
10
|
Starren JB, Tierney WM, Williams MS, Tang P, Weir C, Koppel R, Payne P, Hripcsak G, Detmer DE. A retrospective look at the predictions and recommendations from the 2009 AMIA policy meeting: did we see EHR-related clinician burnout coming? J Am Med Inform Assoc 2021; 28:948-954. [PMID: 33585936 PMCID: PMC8068422 DOI: 10.1093/jamia/ocaa320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022] Open
Abstract
Clinicians often attribute much of their burnout experience to use of the electronic health record, the adoption of which was greatly accelerated by the Health Information Technology for Economic and Clinical Health Act of 2009. That same year, AMIA's Policy Meeting focused on possible unintended consequences associated with rapid implementation of electronic health records, generating 17 potential consequences and 15 recommendations to address them. At the 2020 annual meeting of the American College of Medical Informatics (ACMI), ACMI fellows participated in a modified Delphi process to assess the accuracy of the 2009 predictions and the response to the recommendations. Among the findings, the fellows concluded that the degree of clinician burnout and its contributing factors, such as increased documentation requirements, were significantly underestimated. Conversely, problems related to identify theft and fraud were overestimated. Only 3 of the 15 recommendations were adjudged more than half-addressed.
Collapse
Affiliation(s)
- Justin B Starren
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William M Tierney
- Internal Medicine, Population Health, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Paul Tang
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Charlene Weir
- Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ross Koppel
- Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Biomedical Informatics, State University of New York Buffalo, Buffalo, New York, USA
| | - Philip Payne
- Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - George Hripcsak
- Biomedical Informatics, Columbia University, New York, New York, USA
| | - Don E Detmer
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|