Arias Pou Paloma, Aquerreta Gonzalez Irene, Idoate García Antonio, Garcia-Fernandez Nuria
Hospital Pharmacy, Clínica Universidad de Navarra, Madrid, Spain.
Hospital Pharmacy, Clínica Universidad de Navarra, Pamplona, Spain.
Eur J Hosp Pharm. 2019 Jan;26(1):33-38. doi: 10.1136/ejhpharm-2017-001300. Epub 2017 Sep 14.
Electronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI.
The study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians.
One-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01).
A CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.
电子警报系统已显示出其在改善急性肾损伤（AKI）检测方面的能力。本研究的目的是设计并实施一种临床决策支持系统（CDSS），以改善药物选择并减少AKI患者中肾毒性药物的使用。
本研究设计为一项干预性研究，比较分别于2014年4月和2015年4月入院的患者的前后队列（第一阶段和第二阶段）。干预措施是一个提供肾功能和肾毒性药物信息的CDSS。此外，设计了一个中断性警报，以检测正在服用肾毒性药物的AKI事件患者，并查看医生随后是否降低了剂量或停用了药物。
三分之一的住院患者被纳入分析，因为他们符合纳入标准（第一阶段和第二阶段分别有1004例和1002例患者）。其中735例和761例至少收到一次肾毒性警报（73%对76%；p=0.763）。65例和88例患者在入院期间发生AKI（6.5%对8.8%；p=0.051）。在第一阶段，患者收到384次肾毒性警报（55%），其中78次（20%）促使肾毒性药物发生改变或停用。在第二阶段，实施CDSS后，这一数值在526次警报中增加到154次（29%）（p<0.01）。
具有中断性警报的CDSS，能实时告知肾毒性药物处方患者AKI的发生情况，对合理使用这些药物有积极影响。
