Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury

A.B. McCoy; Z.L. Cox; E.B. Neal; L.R. Waitman; N.B. Peterson; G. Bhave; E.D. Siew; I. Danciu; J.B. Lewis; J.F. Peterson

doi:10.4338/ACI-2012-03-RA-0009

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2012; 03(02): 221-238
DOI: 10.4338/ACI-2012-03-RA-0009

Research Article

Schattauer GmbH

Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury

A randomized, controlled trial

Authors

A.B. McCoy

¹Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
Z.L. Cox

²Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN

³College of Pharmacy, Lipscomb University, Nashville, TN
E.B. Neal

²Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
L.R. Waitman

⁴Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
N.B. Peterson

⁵Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
G. Bhave

⁶Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
E.D. Siew

⁶Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
I. Danciu

¹Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
J.B. Lewis

⁶Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
J.F. Peterson

¹Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN

⁵Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN

⁷Geriatric Research Education Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN

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 alerts

Keywords

Clinical decision support systems - electronic health records - randomized controlled trial - medication errors - medication error prevention and control - adverse drug reaction reporting systems

Full Text

References

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