Appl Clin Inform 2012; 03(02): 221-238
DOI: 10.4338/ACI-2012-03-RA-0009
Research Article
Schattauer GmbH

Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury

A randomized, controlled trial
A.B. McCoy
1  Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
,
Z.L. Cox
2  Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
3  College of Pharmacy, Lipscomb University, Nashville, TN
,
E.B. Neal
2  Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
,
L.R. Waitman
4  Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
,
N.B. Peterson
5  Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
,
G. Bhave
6  Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
,
E.D. Siew
6  Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
,
I. Danciu
1  Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
,
J.B. Lewis
6  Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
,
J.F. Peterson
1  Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
5  Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
7  Geriatric Research Education Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
› Author Affiliations
Further Information

Publication History

received: 23 March 2012

accepted: 29 May 2012

Publication Date:
16 December 2017 (online)

Summary

Objectives: Clinical decision support (CDS), such as computerized alerts, improves prescribing in the setting of acute kidney injury (AKI), but considerable opportunity remains to improve patient safety. The authors sought to determine whether pharmacy surveillance of AKI patients could detect and prevent medication errors that are not corrected by automated interventions.

Methods: The authors conducted a randomized clinical trial among 396 patients admitted to an academic, tertiary care hospital between June 1, 2010 and August 31, 2010 with an acute 0.5 mg/dl change in serum creatinine over 48 hours and a nephrotoxic or renally cleared medication order. Patients randomly assigned to the intervention group received surveillance from a clinical pharmacist using a web-based surveillance tool to monitor drug prescribing and kidney function trends. CDS alerting and standard pharmacy services were active in both study arms. Outcome measures included blinded adjudication of potential adverse drug events (pADEs), adverse drug events (ADEs) and time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications.

Results: Potential ADEs or ADEs occurred for 104 (8.0%) of control and 99 (7.1%) of intervention patient-medication pairs (p=0.4). Additionally, the time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications did not differ between control and intervention patients (33.4 hrs vs. 30.3hrs, p=0.3).

Conclusions: Pharmacy surveillance had no incremental benefit over previously implemented CDS alerts