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Job Title
Pharmacy Informatics and Outcomes Research Fellow
Academic Rank
Fellow or Postdoc
Department
Medicine
Authors
Rachel L. Wasserman, PharmD, Diane L. Seger, RPh, Mary G. Amato, PharmD, MPH, Julie Fiskio, BS, David W. Bates, MD, MSc
Principal Investigator
David W. Bates, MD, MSc
Categories
Tags
A risk factor for a potentially fatal arrhythmia, Torsade de Pointes, is a prolongation in the heart rate-corrected QT interval (QTc) above 500 milliseconds. Current Clinical Decision Support (CDS) Drug-Drug Interaction (DDI) alerts in the electronic health record are provided by medication knowledge vendors and usually exclude patient-specific factors. The Tisdale risk score calculator uses easily obtainable clinical variables to predict which hospitalized patients are at the highest risk for QTc prolongation. The goal of the study was to determine the rate of QTc DDI overrides and Tisdale risk scores. A secondary outcome was to determine the rate of Adverse Drug Events associated with overrides. Partners Enterprise Data Warehouse was used to retrospectively access QTc DDI alerts fired for patients > 18 years old admitted to Brigham and Women’s Hospital during 01/01/2022-12/31/2022. A total of 2,649 patients with 3,033 patient admissions had 18,432 QTc DDI alerts overridden. An average of 3 unique QTc DDI alerts fired per patient admission and alerts were overridden on average 6 times. We found 6% of patient admissions were low risk, 64% moderate, and 30% high risk. The Tisdale calculator provides another level of support for healthcare providers in treatment decisions and decreases alert fatigue.
A risk factor for a potentially fatal irregular heartbeat, Torsade de Pointes, is a prolongation of the QT interval (QTc) on the electrocardiogram above 500 milliseconds. Current Drug-Drug Interaction (DDI) alerts in the electronic health record (EHR) focuses on the two drugs and excludes other patient clinical information. The Tisdale risk score calculator uses patient information available in their EHR to predict which hospitalized patients are at the highest risk for QTc prolongation. The goal of the study was to determine how often providers did not accept the QTc DDI alert recommendations and calculate Tisdale risk scores. A secondary outcome was to determine the rate of Adverse Drug Events associated with unaccepted alerts. The study accessed QTc DDI alerts fired for patients > 18 years old admitted to Brigham and Women’s Hospital during 01/01/2022-12/31/2022. A total of 2,649 patients with 3,033 patient admissions had 18,432 QTc DDI alerts not accepted. An average of 3 unique QTc DDI alerts fired per patient admission and alerts were not accepted on average 6 times. We found 6% of patient admissions were low risk, 64% moderate, and 30% high risk. The Tisdale calculator provides another level of support for healthcare providers in treatment decisions.
