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Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes.

Authors
  • Sorita, Atsushi1
  • Bos, J Martijn2
  • Morlan, Bruce W3
  • Tarrell, Robert F4
  • Ackerman, Michael J5
  • Caraballo, Pedro J6
  • 1 Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • 2 Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • 3 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
  • 4 Division of Biostatistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA.
  • 5 Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA.
  • 6 Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Type
Published Article
Journal
Journal of the American Medical Informatics Association
Publisher
Oxford University Press
Publication Date
Apr 01, 2015
Volume
22
Issue
e1
Identifiers
DOI: 10.1136/amiajnl-2014-002896
PMID: 25324555
Source
Medline
Keywords
License
Unknown

Abstract

We developed and implemented a 'CPOE-QT Alert' system, that is, clinical decision support integrated in the computerized physician order entry system (CPOE), in 2011. The system identifies any attempts to order medications with risk of torsade de pointes (TdP) for patients with a history of significant QT prolongation (QTc ≥500 ms) and alerts the provider entering the order. We assessed its impact by comparing orders and subsequent medication administration before and after activation of the system. We found a significant decrease in the proportion of completed order per ordering attempt after system activation (94% (1293/1379) vs 77% (1888/2453), difference 16.8%; p<0.001). This resulted in a 13.9% reduction in the administration of those medications to patients. A significant decrease was observed across all provider types, educational levels, and specialties. The CPOE-QT Alert system successfully reduced exposure to QT-prolonging medications in high risk patients.

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