Achieving Medication Safety During Acute Kidney Injury
The utilization of clinical decision support (CDS) is increasing among healthcare facilities which have implemented computerized physician order entry or electronic medical records. Formal prospective evaluation of CDS implementations occurs rarely, and misuse or flaws in system design are often unrecognized. Retrospective review can identify failures but is too late to make critical corrections or initiate redesign efforts. A real-time surveillance dashboard for high-alert medications integrates externalized CDS interactions with relevant medication ordering, administration, and therapeutic monitoring data. The surveillance view of the dashboard displays all currently admitted, eligible patients and provides brief demographics with triggering order, laboratory, and CDS failure data to allow prioritization of high-risk scenarios. The patient detail view displays a detailed timeline of orders, order administrations, laboratory values, and CDS interactions for an individual patient and allows users to understand provider actions and patient condition changes occurring in conjunction with CDS failures. Clinical pharmacists' use of the dashboard for patient monitoring and intervention aims to increase the rate and timeliness of intercepted medication errors compared to CPOE-based CDS in the setting of acute kidney injury, which affects patients at various points across all hospital units and services and has numerous opportunities for intervention.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||Achieving Medication Safety During Acute Kidney Injury: The Impact of Clinical Decision Support and Real-Time Pharmacy Surveillance|
- Adverse Drug Events or Potential Adverse Drug Events [ Time Frame: Until patient discharge (~2 week average) ] [ Designated as safety issue: Yes ]Our primary outcome measured the rate of AKI-related ADEs and pADEs. We defined pADEs as incidents with the potential for injury related to a drug, such as use of a non-steroidal anti-inflammatory drug for at least 24 hours, and ADEs as injuries resulting from the administration of a drug, such as a toxic vancomycin trough level or a bleed after administration of enoxaparin. We measured outcomes after completion of the inpatient encounter (either by death or discharge); pADEs or ADEs occurring after patient discharge were not included in the analysis.
- Time to Provider Response [ Time Frame: Until patient discharge (~2 week average) ] [ Designated as safety issue: Yes ]Time from study event to modification or discontinuation of targeted medication
|Study Start Date:||June 2010|
|Study Completion Date:||August 2010|
|Primary Completion Date:||August 2010 (Final data collection date for primary outcome measure)|
Patients appear on dashboard and are eligible for pharmacy intervention in addition to existing clinical decision support interventions.
Other: Pharmacy Dashboard Review and Intervention
Clinical pharmacist reviews patients on dashboard and makes intervention with providing team when necessary.
No Intervention: Control
Patients do not appear on dashboard for pharmacy intervention, but only receive existing clinical decision support interventions.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01134900
|United States, Tennessee|
|Vanderbilt University Medical Center|
|Nashville, Tennessee, United States, 37235|
|Principal Investigator:||Allison B McCoy, PhD||The University of Texas Health Science Center at Houston (UTHealth)|
|Principal Investigator:||Josh F Peterson, MD, MPH||Vanderbilt University|