Tisdale James E, Jaynes Heather A, Kingery Joanna R, Overholser Brian R, Mourad Noha A, Trujillo Tate N, Kovacs Richard J
From the Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN (J.E.T., H.A.J., B.R.O., N.A.M.); Department of Medicine, School of Medicine, Indiana University, Indianapolis (J.E.T., B.R.O., R.J.K.); Department of Pharmacy, Indiana University Health Methodist Hospital, Indianapolis (J.R.K., T.N.T.).
Circ Cardiovasc Qual Outcomes. 2014 May;7(3):381-90. doi: 10.1161/CIRCOUTCOMES.113.000651. Epub 2014 May 6.
We evaluated the effectiveness of a computer clinical decision support system (CDSS) for reducing the risk of QT interval prolongation in hospitalized patients.
We evaluated 2400 patients admitted to cardiac care units at an urban academic medical center. A CDSS incorporating a validated risk score for QTc prolongation was developed and implemented using information extracted from patients' electronic medical records. When a drug associated with torsades de pointes was prescribed to a patient at moderate or high risk for QTc interval prolongation, a computer alert appeared on the screen to the pharmacist entering the order, who could then consult the prescriber on alternative therapies and implement more intensive monitoring. QTc interval prolongation was defined as QTc interval >500 ms or increase in QTc of ≥60 ms from baseline; for patients who presented with QTc >500 ms, QTc prolongation was defined solely as increase in QTc ≥60 ms from baseline. End points were assessed before (n=1200) and after (n=1200) implementation of the CDSS. CDSS implementation was independently associated with a reduced risk of QTc prolongation (adjusted odds ratio, 0.65; 95% confidence interval, 0.56-0.89; P<0.0001). Furthermore, CDSS implementation reduced the prescribing of noncardiac medications known to cause torsades de pointes, including fluoroquinolones and intravenous haloperidol (adjusted odds ratio, 0.79; 95% confidence interval, 0.63-0.91; P=0.03).
A computer CDSS incorporating a validated risk score for QTc prolongation influences the prescribing of QT-prolonging drugs and reduces the risk of QTc interval prolongation in hospitalized patients with torsades de pointes risk factors.
我们评估了计算机临床决策支持系统（CDSS）在降低住院患者QT间期延长风险方面的有效性。
我们对一家城市学术医疗中心心脏监护病房收治的2400例患者进行了评估。利用从患者电子病历中提取的信息，开发并实施了一个包含经过验证的QTc延长风险评分的CDSS。当给QTc间期延长风险为中度或高度的患者开具与尖端扭转型室速相关的药物时，计算机屏幕上会向录入医嘱的药剂师发出警报，药剂师随后可就替代疗法咨询开处方者并实施更密切的监测。QT间期延长定义为QTc间期>500毫秒或QTc较基线增加≥60毫秒；对于QTc>500毫秒的患者，QT间期延长仅定义为QTc较基线增加≥60毫秒。在实施CDSS之前（n = 1200）和之后（n = 1200）对终点进行了评估。实施CDSS与降低QTc延长风险独立相关（校正比值比，0.65；95%置信区间，0.56 - 0.89；P<0.0001）。此外，实施CDSS减少了已知可引起尖端扭转型室速的非心脏药物的处方，包括氟喹诺酮类药物和静脉注射氟哌啶醇（校正比值比，0.79；95%置信区间，0.63 - 0.91；P = 0.03）。
一个包含经过验证的QTc延长风险评分的计算机CDSS会影响延长QT药物的处方，并降低有尖端扭转型室速风险因素的住院患者QT间期延长的风险。
