A System to Improve Medication Safety in the Setting of Acute Kidney Injury: Initial Provider Response

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Clinical decision support systems can decrease common errors related to inadequate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a set of care provider order entry interventions with varying levels of workflow intrusiveness to continuously monitor for and alert providers about acute kidney injury. Initial provider response to the interventions shows potential success in improving medication safety and suggests future enhancements to increase effectiveness.

Technology Health & Medicine

A System to Improve Medication Safety in the Setting of Acute Kidney Injury: Initial Provider Response INTRODUCTION Hospital-acquired acute kidney injury (AKI) occurs frequently among inpatients. Many patients with AKI receive inappropriate doses for nephrotoxic or renally cleared drugs. Clinical decision support embedded in computerized provider order entry (CPOE) systems can reduce medication errors. INTERVENTION A comprehensive computerized provider order entry (CPOE) intervention alerted providers about 0.5 mg/dl or greater increases in serum creatinine in patients receiving nephrotoxic or renally cleared drugs. Passive alerts appeared as persistent text within the CPOE system and on printed rounding reports, requiring no provider response. Providers could click on the displayed text to view more detailed information. RESULTS We evaluated 2733 AKI events with an associated medication order. After viewing only a passive alert, providers modified or discontinued 27.1% of medication orders. Providers clicked on less than 1% of displayed passive alerts. Though providers often initially deferred the intrusive alerts, most associated medication orders were later modified, discontinued, or marked as correct. For those intrusive alerts providers selected to initially defer, providers continued to select the “defer” response a median of 5 times. Allison B. McCoy, MS Josh F. Peterson, MD, MPH Cynthia S. Gadd, PhD, MBA, MS Ioana Danciu, BE Lemuel R. Waitman, PhD Department of Biomedical Informatics Vanderbilt University Medical Center OBJECTIVE: To evaluate initial provider interactions with clinical decision support alerts, which aim to improve medication safety following acute kidney injury. CONCLUSION Our initial evaluation shows that providers will respond to AKI alerts by modifying or discontinuing more than half of alerted orders. Providers delay decisions by repeatedly deferring the alerts. Future enhancements will address frequent deferrals by involving other team members in making mid-regimen prescription decisions. ACKNOWLEDGEMENT This work was funded by NLM grants T15 LM007450-07 and R03 LM009238-02. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Intrusive Alert Responses Intervention Passive Alert Intrusive Alert

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