 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||
|
|||||||||||
Critical Care Pharmacy Resident, Department of Pharmacy Services, Virginia Commonwealth University Health System, 401 North 12th Street, Box 980042, Richmond, Virginia 23298, fax 804/225-3920, censor{at}mcvh-vcu.edu
Director, Drug Information Services, Virginia Commonwealth University Health System
Informatics Pharmacist, Virginia Commonwealth University Health System
Clinical Pharmacy Specialist, Internal Medicine, Virginia Commonwealth University Health System
Published Online, May 19, 2009. www.theannals.com, DOI 10.1345/aph.1L714
|
Methods. Virginia Commonwealth University Health System is a 779-bed, level 1 tertiary care academic medical center. In 2007, the number of ESA orders entered into the CPOE system was 1396. The ESA rule was designed to query 3 areas in the CPOE system in which hemoglobin values are reported when ESAs are prescribed: laboratory, blood gas, and point-of-care testing sections. If, during this query, the hemoglobin level was greater than 12 g/dL within the previous 48 hours, prescribers were alerted with a pop-up box that included the black box warning and dosing recommendations. This alert required prescribers to either cancel order entry or actively override the alert by selecting the choice in the override reason dialog box (treatment plan requirement) or entering a free-text reason. After the rule went live on November 1, 2007, a weekly report was generated to monitor and record its activity and the action taken after the alert fired (overridden and ordered or not ordered). An evaluation from November 1, 2007, to February 28, 2008, was conducted to determine whether the ESA rule deterred prescribing when the hemoglobin level was greater than 12 g/dL. This analysis received expedited approval from the institutional review board at Virginia Commonwealth University.
Results. During the evaluation period, 490 ESA orders were entered into the CPOE system. A sample (n = 98) of these orders was assessed. All orders in which the rule fired (n = 18) were included in the sample. Indications for ESA use included: CKD (57), off-label (30), myelosuppressive chemotherapy (7), and allogenic blood transfusion reduction (4). The CPOE rule fired in 3.7% (18/490) of ESA orders during the analysis. It stopped ESA prescribing 94% (17/18) of the time. For the one alert override, the indication was CKD, hemoglobin level was 12.6 g/dL, and treatment plan requirement was selected by the prescriber. Adverse effects from ESA administration were not noted for this patient.
Discussion. We have validated the effectiveness of the rule we created by demonstrating a high percentage (>94%) of ESA orders prevented. Importantly, the override functionality was utilized in only one case during the analysis. Limitations include the study's retrospective design and short time period. A more longitudinal analysis to discern rule effectiveness is needed.
Footnotes
This work was presented in poster form at the 43rd annual American Society of Health-System Pharmacists Midyear Clinical Meeting, Orlando, Florida, December 9, 2008.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
 |
