J Am Med Inform Assoc - Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes.

Tópicos

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Resumo

We developed and implemented a 'CPOE-QT Alert' system, that is, clinical decision support integrated in the computerized physician order entry system (CPOE), in 2011. The system identifies any attempts to order medications with risk of torsade de pointes (TdP) for patients with a history of significant QT prolongation (QTc =500 ms) and alerts the provider entering the order. We assessed its impact by comparing orders and subsequent medication administration before and after activation of the system. We found a significant decrease in the proportion of completed order per ordering attempt after system activation (94% (1293/1379) vs 77% (1888/2453), difference 16.8%; p<0.001). This resulted in a 13.9% reduction in the administration of those medications to patients. A significant decrease was observed across all provider types, educational levels, and specialties. The CPOE-QT Alert system successfully reduced exposure to QT-prolonging medications in high risk patients.

Resumo Limpo

develop implement cpoeqt alert system clinic decis support integr computer physician order entri system cpoe system identifi attempt order medic risk torsad de point tdp patient histori signific qt prolong qtc ms alert provid enter order assess impact compar order subsequ medic administr activ system found signific decreas proport complet order per order attempt system activ vs differ p result reduct administr medic patient signific decreas observ across provid type educ level specialti cpoeqt alert system success reduc exposur qtprolong medic high risk patient

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