Department of Pharmacy, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States.
Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, United States.
Appl Clin Inform. 2022 Jan;13(1):19-29. doi: 10.1055/s-0041-1740483. Epub 2022 Jan 5.
The aim of the study is to implement a customized QTc interval clinical decision support (CDS) alert strategy in our electronic health record for hospitalized patients and aimed at providers with the following objectives: minimize QTc prolongation, minimize exposure to QTc prolonging medications, and decrease overall QTc-related alerts. A strategy that was based on the validated QTc risk scoring tool and replacing medication knowledge vendor alerts with custom QTc prolongation alerts was implemented.
This is a retrospective quasi-experimental study with a pre-intervention period (August 2019 to October 2019) and post-intervention period (December 2019 to February 2020). The custom alert was implemented in November 2019.
In the pre-implementation group, 361 (19.3%) patients developed QTc prolongation, and in the post-implementation group, 357 (19.6%) patients developed QTc prolongation (OR: 1.02, 95% CI: 0.87-1.20, = 0.81). The odds ratio of an action taken post-implementation compared with pre-implementation was 18.90 (95% CI: 14.03-25.47, <0. 001). There was also a decrease in total orders for QTc prolonging medications from 7,921 (5.5%) to 7,566 (5.3%) with an odds ratio of 0.96 (95% CI: 0.93-0.99, = 0.01).
We were able to decrease patient exposure to QTc prolonging medications while not increasing the rate of QTc prolongation as well as improving alert action rate. Additionally, there was a decrease in QTc prolonging medication orders which illustrates the benefit of using a validated risk score with a customized CDS approach compared with a traditional vendor-based strategy. Further research is needed to confirm if an approach implemented at our organization can reduce QTc prolongation rates.
本研究旨在为住院患者实施电子病历中定制的 QTc 间期临床决策支持（CDS）警报策略，并针对以下目标的提供者：最小化 QTc 延长，最小化暴露于 QTc 延长药物，减少整体 QTc 相关警报。实施了一种基于经过验证的 QTc 风险评分工具并以定制的 QTc 延长警报替代药物知识供应商警报的策略。
这是一项回顾性准实验研究，包括干预前（2019 年 8 月至 2019 年 10 月）和干预后（2019 年 12 月至 2020 年 2 月）两个阶段。定制警报于 2019 年 11 月实施。
在实施前组中，有 361 名（19.3%）患者发生 QTc 延长，在实施后组中，有 357 名（19.6%）患者发生 QTc 延长（OR：1.02，95%CI：0.87-1.20， = 0.81）。与实施前相比，实施后的行动可能性比为 18.90（95%CI：14.03-25.47，<0.001）。与 QTc 延长药物的总订单数也从 7921（5.5%）下降到 7566（5.3%），比值比为 0.96（95%CI：0.93-0.99， = 0.01）。
我们能够降低患者暴露于 QTc 延长药物的风险，同时不会增加 QTc 延长的发生率，并且提高了警报行动率。此外，还减少了 QTc 延长药物的订单数量，这说明了与传统的供应商策略相比，使用经过验证的风险评分和定制的 CDS 方法的好处。需要进一步的研究来确认我们组织实施的方法是否可以降低 QTc 延长率。
