Patient Safety Clinical Program Pilot

1. Patient Safety Clinical Program Pilot QTc Alert System

2. Why? • Data at peer reviewed meetings (AHA) indicate that a high percent of patients with QT prolongation receive additional QT prolonging medications • Current multum alerts do not risk stratify interactions or provide risk factor details • Improve patient safety!

3. Who? • Team Sponsors • Dr. Niemeier, Joanna Kingery, Tate Trujillo • Research Team • Jim Tisdale, Heather Wroblewski, Dr. Kovacs • Pharmacy Team E • Phillip, Calea, Shawn, Chelsea, Sarah S., Dustin, Alex • IS/PharmNet Team • Jason Eder, Steve Peters, Adam Johnson

4. What? • Cardiology & Pharmacy collaboration • Hardwired system to identify patients at high risk for QT prolongation • Tool has been validated that can risk stratify patients based on: • Clinical profile • Labs • ECG data • Medication lists

5. How? • Program is within the scope of pharmacists’ practice • Pilot on 4E/5E prior to housewide roll-out • Physicians may receive notification of high risk patients identified with new alert system • Alert fires if existing QTc prolongation or greater than 80% chance of developing prolongation

6. QTc Interval Prolongation Discern Alert Fires QT Interval Alert Process Flow Order Entry Pharmacist Calls Ordering MD MD wants to continue with current drug (no change) MD Changes to different drug MD asks for Alternative Drug Document conversation with MD in alert comments Process End Kinetics Pager Appropriate Clinical Pharmacist or Reference List of Alternatives for Guidance Enter “Pharmacy to Dose (no page)” consult Add to Order Comments for Pharmacy to dose: F/up on QT Interval Prolongation Alert Resident to reconcile list and alert appropriate Clinical Pharmacist

7. IV to PO Generated Alerts QTc Interval Prolongation Discern Alert Fires History  Alert History  “Discern” Pull Up Discern Hx to See if Alert Fired when IV medication entered If no alert fired for IV form of same med, Pharmacist needs to call ordering MD (risk of QT interval prolongation has increased) If alert fired for IV form of same med, proceed with processing order for PO form (assume call was made with first alert)

8. How often? Summary of QTc Alert System Firing Over 14 Days in 4E/5E

9. Alert if Risk Score > 11

10. Alert if QTc > 500 msec

11. When? • Go-live next Monday, 9/13! • 4E/5E pilot • Housewide rollout TBD