A System to Improve Medication Safety in the Setting of Acute Kidney Injury

1. Pre-Intervention Post-Intervention Results A System to Improve Medication Safety in the Setting of Acute Kidney Injury Intervention A passive alert appeared as persistent text within the CPOE system and on rounding reports, requiring no provider response. An intrusive alert interrupted the provider at the end of the CPOE session, requiring the provider to modify or discontinue the drug order, assert that the current dose was correct, or deferthe alert to reappear in the next CPOE session. MEASUREMENTSWe evaluated the interventions, using as our outcomes the rate of order modification or discontinuation within 24 hours, the time to modification or discontinuation, and the provider response to the alerts. RESULTSThe rate of order modification or discontinuation increased from 40.1 to 61 actions per 100 events (p < 0.001) for high toxicity drugs and 38.9 to 48.4 actions per 100 events (p < 0.001) for moderate toxicity drugs. The mediantime to order modification or discontinuation decreased from 28.3 to 10.2 hours (p < 0.001) for high toxicity drugs and 31.1 to 20.4 hours (p < 0.001) for moderate toxicity drugs. After viewing only a passive alert, providers modified or discontinued 26.9% of orders. For those not immediately modified or discontinued, providers chose to initially defer 78.1% of the intrusive alerts. Providers selected “modify” or “discontinue” as the terminal response during 12.2%and 8.1% of the displayed intrusive alerts respectively, and “correct dose” during 42.5%. CONCLUSIONThe intervention improved provider response to AKI, though frequent provider deferrals suggested future enhancements to increase success. ACKNOWLEDGEMENT: This work was funded by T15 LM007450-06 and R03 LM009238-02. Passive Alert Allison B. McCoy, MS Josh F. Peterson, MD, MPH Cynthia S. Gadd, PhD, MBA, MS Lemuel R. Waitman, PhD Department of Biomedical Informatics Vanderbilt University Medical Center OBJECTIVE: To improve provider response to acute kidney injury using a computerized provider order entry intervention. INTRODUCTIONInadequate dosing for nephrotoxic or renally cleared drugs in patients with acute kidney injury (AKI) is common, though recent clinical decision support systems have proven successful in decreasing errors. INTERVENTIONA computerized provider order entry (CPOE) intervention alerted providers about 0.5 mg/dl or greater increases in serum creatinine, advising discontinuation or modification of nephrotoxic or renally cleared drugs. Intrusive Alert

2. Implementation Sciences The Department of Biomedical Informatics has a number of full-time faculty, clinical faculty and students studying biomedical informatics and adoption of information-based systems. Research in the understanding of why people do or do not adopt new technology, processes, and other innovations is primarily qualitative and people/organization-based. Vanderbilt Implementation Sciences Laboratory Implementation Chasm Lorenzi NM, Novak LL, Weiss JB, Gadd CS, Unertl KM. Crossing the Implementation Chasm: A Proposal for Bold Action. Journal of the American Medical Informatics Association 15(3) May/June 2008. Nancy Lorenzi, PhD, MLS, MA, Director Department of Biomedical Informatics Vanderbilt University Medical Center OBJECTIVE: The Implementation Sciences Laboratory (ISL) in the Department of Biomedical Informatics is a community of scholars interested in achieving implementation goals for information-based systems to support operations, research, and education in complex healthcare organizations.. . CURRENT PROJECTS Current Implementation Sciences Laboratory Projects are focused on three areas of translational research: Understanding and improving adoption of technology-enabled treatment strategies Gaining clinical acceptance of Evidence-Based Medicine by clinicians Developing strategies, processes, and methods that lead to greater adoption and acceptance for community health research.