Providers’ Response to Clinical Decision Support for QT Prolonging Drugs

Sunita Sharma, J. Martijn Bos, Robert F. Tarrell, Gyorgy J. Simon, Bruce W. Morlan, Michael John Ackerman, Pedro Caraballo

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Commonly used drugs in hospital setting can cause QT prolongation and trigger life-threatening arrhythmias. We evaluate changes in prescribing behavior after the implementation of a clinical decision support system to prevent the use of QT prolonging medications in the hospital setting. We conducted a quasi-experimental study, before and after the implementation of a clinical decision support system integrated in the electronic medical record (QT-alert system). This system detects patients at risk of significant QT prolongation (QTc>500ms) and alerts providers ordering QT prolonging drugs. We reviewed the electronic health record to assess the provider’s responses which were classified as “action taken” (QT drug avoided, QT drug changed, other QT drug(s) avoided, ECG monitoring, electrolytes monitoring, QT issue acknowledged, other actions) or “no action taken”. Approximately, 15.5% (95/612) of the alerts were followed by a provider’s action in the pre-intervention phase compared with 21% (228/1085) in the post-intervention phase (p=0.006). The most common type of actions taken during pre-intervention phase compared to post-intervention phase were ECG monitoring (8% vs. 13%, p=0.002) and QT issue acknowledgment (2.1% vs. 4.1%, p=0.03). Notably, there was no significant difference for other actions including QT drug avoided (p=0.8), QT drug changed (p=0.06) and other QT drug(s) avoided (p=0.3). Our study demonstrated that the QT alert system prompted a higher proportion of providers to take action on patients at risk of complications. However, the overall impact was modest underscoring the need for educating providers and optimizing clinical decision support to further reduce drug-induced QT prolongation.

Original languageEnglish (US)
Article number161
JournalJournal of Medical Systems
Volume41
Issue number10
DOIs
StatePublished - Oct 1 2017

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Keywords

  • Clinical decision support systems
  • Electrocardiogram
  • Medical informatics
  • Medical order entry systems
  • Prolonged QT interval
  • Torsades de pointes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Information Systems
  • Health Informatics
  • Health Information Management

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