Reducing Prescribing Errors in Hospitalized Children on the Ketogenic Diet
| Autor: | Philip J. Holt, Emily Kurzen, Evan W. Orenstein, David S. Wolf, Meredith Johnson, Benjamin I Siegel, Thomas E. Dawson |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Carbohydrates Clinical decision support system Medical Order Entry Systems 03 medical and health sciences Patient safety Epilepsy 0302 clinical medicine Developmental Neuroscience 030225 pediatrics Intervention (counseling) medicine Humans Medication Errors Medical prescription Child business.industry Infant Ketosis medicine.disease Decision Support Systems Clinical Confidence interval Neurology Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Neurology (clinical) Patient Safety business Diet Ketogenic Child Hospitalized 030217 neurology & neurosurgery Ketogenic diet |
| Zdroj: | Pediatric neurology. 115 |
| ISSN: | 1873-5150 |
| Popis: | Background Children on the ketogenic diet must limit carbohydrate intake to maintain ketosis and reduce seizure burden. Patients on ketogenic diet are vulnerable to harm in the hospital setting where carbohydrate-containing medications are commonly prescribed. We developed clinical decision support to reduce inappropriate prescription of carbohydrate-containing medications in hospitalized children on ketogenic diet. Methods A clinical decision support alert was developed through formative and summative usability testing. The alert warned prescribers when they entered an order for a carbohydrate-containing medication in patients on ketogenic diet. The alert was implemented using a quasi-experimental design with sequential crossover from control to intervention at two tertiary care pediatric hospitals within a single health system. The primary outcome was carbohydrate-containing medication orders per patient-day. Results During the study period, there were 280 ketogenic diet patient admissions totaling 1219 patient-days. The carbohydrate-containing medication order rate declined from 0.69 to 0.35 orders per patient-day (absolute rate reduction 0.34, 95% confidence interval 0.25-0.43), corresponding to 256 inappropriate orders prevented. The alert fired 398 times and was accepted (i.e., the order was removed) 227 times for an overall acceptance rate of 57%. Conclusions Implementation of a clinical decision support alert at order-entry resulted in a sustained reduction in carbohydrate-containing medication orders for hospitalized patients on ketogenic diet without an increase in alert burden. Clinical decision support developed with user-centered design principles can improve patient safety for children on ketogenic diet by influencing prescriber behavior. |
| Databáze: | OpenAIRE |
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