A systematic approach to optimize electronic health record medication alerts in a health system.

Autor: Bhakta SB; Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX.; University of Houston College of Pharmacy, Houston, TX., Colavecchia AC; Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX.; University of Houston College of Pharmacy, Houston, TX., Haines L; Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX., Varkey D; Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX., Garey KW; Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX.
Jazyk: angličtina
Zdroj: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists [Am J Health Syst Pharm] 2019 Apr 08; Vol. 76 (8), pp. 530-536.
DOI: 10.1093/ajhp/zxz012
Abstrakt: Purpose: The effectiveness of a systematic, streamlined approach to optimize drug-drug interaction alerts in an electronic health record for a health system was studied.
Methods: An 81-week quasi-experimental study was conducted to evaluate interventions made to medication-related clinical decision-support (CDS) alerts. Medication-related CDS alerts were systematically reduced using a multi disciplinary healthcare committee. The primary endpoint was weekly overall, modification, and acknowledgement rates of medication alerts after drug-drug interaction reclassification. Secondary endpoints included sub analysis of types of medication alerts (drug-drug interaction and duplicate therapy alerts) and alert use by providers (pharmacist and prescribers). Data was analyzed using interrupted time series regression analysis.
Results: After implementation of the new alert system, total number of weekly inpatient alerts decreased from 68,900 (66,300-70,900) and 50,300 (48,600-53,600) in the postintervention period (p < 0.001). The perentage of alerts acknowledged weekly increased from 11.8% (IQR, 11.4-12.1%) in the preintervention period to 13.7% (IQR, 13.3-14.0%) in the postintervention period (p < 0.001). The percentage of alerts that were modified also increased from 5.0% (IQR, 4.9-5.3%) in the preintervention period to 7.3% (IQR, 7.0-7.6%) in the postintervention period (p < 0.001). Both increases were primarily seen with pharmacists versus other healthcare professionals (p < 0.001).
Conclusion: A committee-led systematic approach to optimizing drug-drug interactions facilitated a significant decrease in the overall number of alerts and an increase in both medication alert acknowledgement and modification rates.
(© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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