Clinician Responses to a Clinical Decision Support Advisory for High Risk of Torsades de Pointes.
Clinician Responses to a Clinical Decision Support Advisory for High Risk of Torsades de Pointes.
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DOI：
10.1161/jaha.122.024338
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发表时间：
2022-06-07
影响因子：
5.4
通讯作者：
Malone, Daniel C.
中科院分区：
文献类型：
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作者：
Gallo, Tyler;Heise, C. William;Woosley, Raymond L.;Tisdale, James E.;Tan, Malinda S.;Gephart, Sheila M.;Antonescu, Corneliu C.;Malone, Daniel C.
尖端扭转型室性心动过速 (TdP) 是一种可能致命的心律失常，通常由药物引起。临床决策支持 (CDS) 可以通过指导高危患者的决策来帮助最大限度地降低 TdP 风险。 CDS 已被证明可以减少 TdP 风险患者的高风险药物处方，但警报常常被忽视。其他风险管理选项可能会纳入 TdP 风险 CDS。我们的目标是评估临床医生针对 CDS 建议采取的行动，该建议使用修改后的 Tisdale QT 风险评分并提供易于选择的管理选项（例如单击）。我们在由 30 家医院组成的大型医疗保健系统中实施了住院 TdP 风险咨询系统。当处方者尝试为 QT 风险评分≥12 的患者订购已知 TdP 风险的药物时，该 CDS 就会出现。 CDS 显示患者特定信息并提供相关管理选项，包括取消违规药物和订购电解质替代方案或心电图。我们回顾性研究了临床医生在建议中采取的行动，并按药物类别分开。在 8 个月期间，发布了 7794 份 TdP 风险建议。抗生素是该建议最常见的触发因素（n=2578，33.1%）。在 2700 份 (34.6%) 的建议中，至少采取了 1 项行动。最常见的行动是进行心电图检查（n=1584，20.3%）。 793 份 (10.2%) 的咨询中收到的药物订单被取消。采取的每项行动的频率因药物类别而异（所有行动的 P<0.05）。修改后的基于 Tisdale QT 风险评分的 CDS 提供了相关的单击管理选项，产生了很高的行动/响应率。临床医生采取的行动因引发 TdP 风险咨询的药物类别而异，但最常见的是进行心电图检查。
Torsade de pointes (TdP) is a potentially fatal cardiac arrhythmia that is often drug induced. Clinical decision support (CDS) may help minimize TdP risk by guiding decision making in patients at risk. CDS has been shown to decrease prescribing of high‐risk medications in patients at risk of TdP, but alerts are often ignored. Other risk‐management options can potentially be incorporated in TdP risk CDS. Our goal was to evaluate actions clinicians take in response to a CDS advisory that uses a modified Tisdale QT risk score and presents management options that are easily selected (eg, single click). We implemented an inpatient TdP risk advisory systemwide across a large health care system comprising 30 hospitals. This CDS was programmed to appear when prescribers attempted ordering medications with a known risk of TdP in a patient with a QT risk score ≥12. The CDS displayed patient‐specific information and offered relevant management options including canceling offending medications and ordering electrolyte replacement protocols or ECGs. We retrospectively studied the actions clinicians took within the advisory and separated by drug class. During an 8‐month period, 7794 TdP risk advisories were issued. Antibiotics were the most frequent trigger of the advisory (n=2578, 33.1%). At least 1 action was taken within the advisory window for 2700 (34.6%) of the advisories. The most frequent action taken was ordering an ECG (n=1584, 20.3%). Incoming medication orders were canceled in 793 (10.2%) of the advisories. The frequency of each action taken varied by drug class (P<0.05 for all actions). A modified Tisdale QT risk score–based CDS that offered relevant single‐click management options yielded a high action/response rate. Actions taken by clinicians varied depending on the class of the medication that evoked the TdP risk advisory, but the most frequent was ordering an ECG.