Original InvestigationPathogenesis and Treatment of Kidney DiseaseA Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement Report
Section snippets
Setting
Vanderbilt University Hospital (Nashville, TN) is an academic tertiary-care facility with more than 500 adult beds and 34,000 admissions annually. During the past decade, Vanderbilt University Hospital care providers have used locally developed and maintained inpatient computerized provider order entry and inpatient/outpatient electronic medical record systems with extensive integrated decision support.30, 31, 32 Existing clinical decision support includes other alerts about drug safety and
Results
The pre- and postintervention periods were not statistically different for patient age, sex, admitting service, need for intensive care unit care, and median number of target drug orders, although patient ethnicities differed slightly (Table 1). Data analyzed in the preintervention period included 914 patients with 1,920 orders for a target drug in the setting of an initial creatinine level increase. Excluded were 39 patients identified as receiving dialysis and 158 patients who died,
Discussion
We developed an alerting system integrated with computerized provider order entry to continuously monitor and inform health care providers about medication safety in the setting of AKI. The intervention significantly improved provider response to increasing creatinine levels, increasing the frequency at which nephrotoxic and renally cleared medications were modified or discontinued. The greatest effect occurred for medications with the highest potential for toxicity. Response rates showed a
Acknowledgements
The authors thank Mark Sullivan, Cori Nelsen, and Titus Daniels for clinical expertise and Randolph Miller for review and insight. Preliminary results were presented as a poster at the 2008 AMIA Annual Symposium, November 8-12, 2008 in Washington, DC.
Support: The authors were funded in part by National Library of Medicine grants T15 LM007450-08 (A.B.M. and C.S.G.), R01 LM009965-02 (A.B.M., J.F.P., L.R.W., and I.D.), and R03 LM009238-02 (J.F.P).
Financial Disclosure: The authors declare that they
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Originally published online as doi:10.1053/j.ajkd.2010.05.024 on August 16, 2010.