Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury
- 1 January 2012
- journal article
- Published by Georg Thieme Verlag KG in Applied Clinical Informatics
- Vol. 03 (02), 221-238
- https://doi.org/10.4338/aci-2012-03-ra-0009
Abstract
Summary Objectives: Clinical decision support (CDS), such as computerized alerts, improves prescribing in the setting of acute kidney injury (AKI), but considerable opportunity remains to improve patient safety. The authors sought to determine whether pharmacy surveillance of AKI patients could detect and prevent medication errors that are not corrected by automated interventions. Methods: The authors conducted a randomized clinical trial among 396 patients admitted to an academic, tertiary care hospital between June 1, 2010 and August 31, 2010 with an acute 0.5 mg/dl change in serum creatinine over 48 hours and a nephrotoxic or renally cleared medication order. Patients randomly assigned to the intervention group received surveillance from a clinical pharmacist using a web-based surveillance tool to monitor drug prescribing and kidney function trends. CDS alerting and standard pharmacy services were active in both study arms. Outcome measures included blinded adjudication of potential adverse drug events (pADEs), adverse drug events (ADEs) and time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications. Results: Potential ADEs or ADEs occurred for 104 (8.0%) of control and 99 (7.1%) of intervention patient-medication pairs (p=0.4). Additionally, the time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications did not differ between control and intervention patients (33.4 hrs vs. 30.3hrs, p=0.3). Conclusions: Pharmacy surveillance had no incremental benefit over previously implemented CDS alertsKeywords
This publication has 44 references indexed in Scilit:
- A framework for evaluating the appropriateness of clinical decision support alerts and responsesJournal of the American Medical Informatics Association, 2012
- Computerized detection of adverse drug reactions in the medical intensive care unitInternational Journal of Medical Informatics, 2011
- Defining Health Information Technology–Related ErrorsArchives of Internal Medicine, 2011
- Comparison of computerized surveillance and manual chart review for adverse eventsJournal of the American Medical Informatics Association, 2011
- Using prospective clinical surveillance to identify adverse events in hospitalBMJ Quality & Safety, 2011
- A Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement ReportAmerican Journal of Kidney Diseases, 2010
- Adverse Drug Event Rates in Six Community Hospitals and the Potential Impact of Computerized Physician Order Entry for PreventionJournal of General Internal Medicine, 2009
- The unintended consequences of computerized provider order entry: Findings from a mixed methods explorationInternational Journal of Medical Informatics, 2009
- Can Surveillance Systems Identify and Avert Adverse Drug Events? A Prospective Evaluation of a Commercial ApplicationJournal of the American Medical Informatics Association, 2008
- Classifying and Predicting Errors of Inpatient Medication ReconciliationJournal of General Internal Medicine, 2008