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Linking Lab and Pharmacy: Clinical Decision Support to Manage Inpatient Hyperkalemia

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posted on 15.04.2014 by Shengsheng Yu
Linking Lab and Pharmacy: Clinical Decision Support to Manage Inpatient Hyperkalemia Shengsheng Yu, PhD Department of Pharmacy Administration University of Illinois at Chicago Chicago, Illinois (2012) Dissertation Chairperson: Bruce Lambert, PhD This study was conducted to evaluate clinicians’ responses to the presence of hyperkalemia before and after implementing laboratory-pharmacy decision support in an inpatient setting. A synchronous and a real-time asynchronous CDS rules were implemented at University of Illinois Hospital (UIH) in June 2003. In May 2010, another once-daily asynchronous drug-laboratory alert report was implemented to detect any missed safety signals. On average, the clinicians’ compliance with the synchronous alerts was 88.31% for [K+]↔ACE/ARB and 69.46% for [K+]↔K-sup. As the indirect effect of the asynchronous CDS alerts, the alert rate of the real-time asynchronous CDS for [K+]↔K-sup dropped significantly after CDS implementation (28.8% vs. 30.4%, p = 0.005). The change in alert rate was not significantly for [K+]↔ACE/ARB (12.1% vs. 12.5%, p = 0.752). The segmented regression analysis indicated that, after controlling for all the covariates, the asynchronous alerts had limited influence on accelerating clinicians’ action for both [K+]↔ACE/ARB and [K+]↔K-sup. Nevertheless, the asynchronous alert had a lasting effect on reducing patient time to normal [K+] for K-sup users. Such benefit was not observed for ACE/ARB users. No significant decrease in the action time to K-sup cancellation was observed immediately after the implementation of once daily report in May 2010. But there was a gradually descending trend given the significant coefficient estimate for the difference in the slope and the negative slope for the post-intervention period. For the action time to K-sup cancellation or repeating [K+], the segmented regression estimates did not confirm the ascending trend for the pre-intervention period, but did ascertain the impact of once daily report in gradually reducing time to either cancel the K-sup order or repeat [K+]. In sum, clinicians complied with synchronous CDS alerts in managing hyperkalemia in inpatient settings. The real-time asynchronous alert failed to demonstrate its effect in accelerating clinicians’ action, but had potential effect in improving patient outcomes for K-sup users. The once daily report was effective in detecting potentially hazardous situations that had not been corrected after real-time asynchronous alert. But its impact on changing clinicians’ practice behavior and improving patient outcomes was difficult to establish given the rare alert rate.

History

Advisor

Lambert, Bruce

Department

Pharmacy Administration

Degree Grantor

University of Illinois at Chicago

Degree Level

Doctoral

Committee Member

Crawford, Stephanie Galanter, William Hedeker, Donald Lee, Todd

Submitted date

2012-05

Language

en

Issue date

10/12/2012

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