Achieving Medication Safety During Acute Kidney Injury

Vanderbilt University

Status: Completed

Conditions: Kidney Failure, Acute

Treatments: Other: Pharmacy Dashboard Review and Intervention

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01134900

R01LM009965 (U.S. NIH Grant/Contract)

081002

Details and patient eligibility

About

The utilization of clinical decision support (CDS) is increasing among healthcare facilities which have implemented computerized physician order entry or electronic medical records. Formal prospective evaluation of CDS implementations occurs rarely, and misuse or flaws in system design are often unrecognized. Retrospective review can identify failures but is too late to make critical corrections or initiate redesign efforts. A real-time surveillance dashboard for high-alert medications integrates externalized CDS interactions with relevant medication ordering, administration, and therapeutic monitoring data. The surveillance view of the dashboard displays all currently admitted, eligible patients and provides brief demographics with triggering order, laboratory, and CDS failure data to allow prioritization of high-risk scenarios. The patient detail view displays a detailed timeline of orders, order administrations, laboratory values, and CDS interactions for an individual patient and allows users to understand provider actions and patient condition changes occurring in conjunction with CDS failures. Clinical pharmacists' use of the dashboard for patient monitoring and intervention aims to increase the rate and timeliness of intercepted medication errors compared to CPOE-based CDS in the setting of acute kidney injury, which affects patients at various points across all hospital units and services and has numerous opportunities for intervention.

Enrollment: 540 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 0.5 mg/dl increase or decrease in serum creatinine within 48 hours
• Active, recurring order for targeted renally cleared or nephrotoxic medication

Exclusion criteria

• Chronic dialysis
• Transplant patients

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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540 participants in 2 patient groups

Dashboard

Experimental group

Description:

Patients appear on dashboard and are eligible for pharmacy intervention in addition to existing clinical decision support interventions.

Treatment:

Other: Pharmacy Dashboard Review and Intervention

Control

No Intervention group

Description:

Patients do not appear on dashboard for pharmacy intervention, but only receive existing clinical decision support interventions.