Posted on April 23, 2015
The positive impact of clinical decision support (CDS) technology continues to increase in tandem with the health IT movement. Technological advances are progressively equipping clinicians with better information at the point of care and the evidence needed to minimize the potential for adverse events.
Consider a typical scenario of how CDS alerts have been used recent years. An attending physician orders the antibiotic ceftriaxone for a patient who has acquired pneumonia. When the attending physician enters an order for the drug, an alert pops up pointing to a medication allergy. Based on the information provided, another appropriate medication is ordered.
While the alert has done its job in helping the physician divert a potential adverse event, the bigger picture of the patient’s outlook has not been considered. Without real-time data providing insight into the patient’s current condition, the physician is unaware of other factors that could render the newly-ordered drug ineffective.
Alerting systems are an important foundational component to the CDS journey, but there are notable limitations to their impact on care delivery when used independent of other resources available in the market. For instance, the data used to generate the alert described in the example is not rich enough to paint a true picture of a patient’s condition in real-time. Also, clinicians will not be able to continue monitoring patient activity once an order is made.
As healthcare organizations grapple with how best to implement technological infrastructures to support performance improvement, the role of CDS must be expanded and layered to deliver more informed alerts. Advances with surveillance technology are meeting this need by providing contextually relevant data regarding a patient’s most current status. By aggregating the wealth of real-time patient information available in EHRs and delivering actionable, meaningful alerts based on preconfigured CDS rules to the point of care, this technology holds great promise in moving care delivery from reactive to proactive.
Healthcare organizations face notable challenges with alert fatigue, especially when alerts are not considered relevant to a specific patient. For one Michigan-based health system, pharmacists received a total of 347 alerts over a 24-hour period for any combination of potassium, ACE/ARB and potassium sparing diuretics, notifying clinicians about the risk of hyperkalemia. Many pharmacists were overriding these alerts because there was no immediate risk in most cases.
The organization turned to Sentri7 as its surveillance solution of choice and was able to turn the situation around by creating a more informed alert. Rather than having a general alert generated for any combination of the three medications, a specific clinical rule was written to identify patients on any possible combination of the targeted medications who were experiencing an absolute potassium serum level greater than 5.5 mEq/L or an increase of greater than 1.0 in the last 48 hours. The alert also included criteria for patients with a CrCl < 30 ml/min since this factor increases the risk of clinically significant hyperkalemia. Because patient care is dynamic in nature, the initial alert may eventually become irrelevant, and further follow-up may be needed. Surveillance technology also expands the monitoring period from a point in time to 24/7 oversight.
It’s a new day for CDS, and healthcare organizations must consider how technological advances can best position them for the evolving performance-based landscape. Advanced surveillance technology like Sentri7 pulls data from disparate systems across an organization, rapidly analyzing patient needs and driving the best clinical decisions in a timely manner.