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Cited by 53Pharmaceutical Practices and Patient OutcomesAcute Kidney Injury ResearchElectronic Health Records Systems

Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury: a randomized, controlled trial

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Cox, Z.L., Neal, E.B., Waitman, L.R., Peterson, N.B., Bhave, G., Siew, E.D., Danciu, I., Lewis, J.B. +2 more·2012·Applied Clinical Informatics
DOI 10.4338/aci-2012-03-ra-0009PMC PMC3377180
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Abstract

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

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  • Institutions have implemented various dashboards that organize and present information from the EHR in a way that is easy to interpret.

    “Similarly, to facilitate alert evaluations, institutions have implemented various dashboards that organize and present information from the EHR in a way that is easy to interpret.29–34”

    From Clinician collaboration to improve clinical decision support: the Clickbusters initiative (2022) · cites this paper as [32]

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Authors
Cox, Z. L., Neal, E. B., Waitman, L. R., Peterson, N. B., Bhave, G., Siew, E. D., Danciu, I., Lewis, J. B., Peterson, J. F., & McCoy, A. B.
Affiliations
  • Lipscomb University (US)
  • Vanderbilt University Medical Center (US)
  • University of Kansas Medical Center (US)
  • Vanderbilt University (US)
Corresponding author
McCoy, A.B.
ORCID
Venue
Applied Clinical Informatics
Publisher
Georg Thieme Verlag KG
Published
2012
Volume
03
Issue
02
Pages
221-238
ISSN
1869-0327 (ISSN-L)
DOI
10.4338/aci-2012-03-ra-0009
PMC
PMC3377180
OpenAlex
W1719489384
Cited by
53
References
2
Citations by year
2025: 3 · 2024: 2 · 2023: 5 · 2022: 11 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 6 · 2016: 5 · 2015: 2 · 2014: 6 · 2013: 3
FWCI
1.72
Type
journal article
Language
en
Open access
Locations
  • Applied Clinical Informatics (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092986)
  • U.S. National Library of Medicine (R01LM009965, T15LM007450)
  • National Center for Research Resources (KL2RR024977, TL1RR024978, UL1RR024975)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
acute kidney injury, clinical decision support, automated alerts, adverse drug reactions, nephrotoxic drugs, medication errors, pharmacist intervention, patient safety, drug discontinuation

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