| A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report. | |
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MedLine Citation:
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PMID: 20709437 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Frequently, prescribers fail to account for changing kidney function when prescribing medications. We evaluated the use of a computerized provider order entry intervention to improve medication management during acute kidney injury. STUDY DESIGN: Quality improvement report with time series analyses. SETTING & PARTICIPANTS: 1,598 adult inpatients with a minimum 0.5-mg/dL increase in serum creatinine level over 48 hours after an order for at least one of 122 nephrotoxic or renally cleared medications. QUALITY IMPROVEMENT PLAN: Passive noninteractive warnings about increasing serum creatinine level appeared within the computerized provider order entry interface and on printed rounding reports. For contraindicated or high-toxicity medications that should be avoided or adjusted, an interruptive alert within the system asked providers to modify or discontinue the targeted orders, mark the current dosing as correct and to remain unchanged, or defer the alert to reappear in the next session. OUTCOMES & MEASUREMENTS: Intervention effect on drug modification or discontinuation, time to modification or discontinuation, and provider interactions with alerts. RESULTS: The modification or discontinuation rate per 100 events for medications included in the interruptive alert within 24 hours of increasing creatinine level improved from 35.2 preintervention to 52.6 postintervention (P < 0.001); orders were modified or discontinued more quickly (P < 0.001). During the postintervention period, providers initially deferred 78.1% of interruptive alerts, although 54% of these eventually were modified or discontinued before patient death, discharge, or transfer. The response to passive alerts about medications requiring review did not significantly change compared with baseline. LIMITATIONS: Single tertiary-care academic medical center; provider actions were not independently adjudicated for appropriateness. CONCLUSIONS: A computerized provider order entry-based alerting system to support medication management after acute kidney injury significantly increased the rate and timeliness of modification or discontinuation of targeted medications. |
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Authors:
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Allison B McCoy; Lemuel R Waitman; Cynthia S Gadd; Ioana Danciu; James P Smith; Julia B Lewis; Jonathan S Schildcrout; Josh F Peterson |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural Date: 2010-08-14 |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 56 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-25 Completed Date: 2010-11-09 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 832-41 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 National Kidney Foundation, Inc. All rights reserved. |
Affiliation:
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Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. allison.mccoy@vanderbilt.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Kidney Injury
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drug therapy* Decision Support Systems, Clinical* Drug Therapy, Computer-Assisted / methods* Female Humans Male Medical Order Entry Systems / organization & administration* Medication Systems, Hospital Middle Aged Prospective Studies Quality Assurance, Health Care / statistics & numerical data* User-Computer Interface* |
| Grant Support | |
ID/Acronym/Agency:
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R01 LM009965-02/LM/NLM NIH HHS; R03 LM009238-02/LM/NLM NIH HHS; T15 LM007450-08/LM/NLM NIH HHS |
| Comments/Corrections | |
Comment In:
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Am J Kidney Dis. 2010 Nov;56(5):809-12
[PMID:
20970021
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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