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Redesign of computerized decision support system to improve Non Vitamin K oral anticoagulant prescribing—A pre and post qualitative and quantitative study
International Journal of Medical Informatics ( IF 4.9 ) Pub Date : 2021-05-31 , DOI: 10.1016/j.ijmedinf.2021.104511
Viviane Khalil 1
Affiliation  

Inappropriate prescribing of non-vitamin K agents (NOAC) contributes to significant economic and personal burden to our society. Studies have shown that when well designed and targeted, computerized alerts can be effective in improving prescribing without contributing to alert fatigue. A collaborative multidisciplinary review group was set up to review and endorse an upgrade and modification to the hospital electronic medication management system (EMS). The intervention focused on implementing tailored electronic patient specific physiological alerts (such as age, renal function weight and drug interactions) built in EMS to improve the appropriateness of NOAC prescribing at this multisite teaching Australian hospital. To assess the qualitative and quantitative impact of the intervention, a pre and post retrospective study of NOAC prescribing of 100 patients’ pre and post the implementation stage was conducted in a multisite Australian 650 bed hospital. Appropriateness of NOAC prescribing was assessed by an experienced pharmacist using approved prescribing product information recommendations. Prescriber satisfaction and experience survey was assessed in both stages of the study using a standard satisfaction survey. Associated hospital acquired complications (HAC) with potential inappropriate NOAC prescribing were evaluated as well as related admission cost and average length of stay. Redesign of computerised decision support in EMS improved appropriateness of NOAC prescribing from 48 % to 91 %, P < 0.05. A total of 67 prescribers accepted the invitation to participate in the qualitative satisfaction study. Half the respondents (n = 33, 50 %) answered positively to a question assessing the usefulness of implementing NOAC alerts in the EMS in improving their practice and patient safety. This rate has increased to 72 % (n = 48) in the post intervention phase. P < 0.05. Additionally, the total number of reported HAC that are likely to be associated with inappropriate NOAC prescribing was reduced by 36 % in the post intervention phase (from 29 to 22 (RR = 0.7454 95 %CI (0.4283−1.2972), P = 0.2986). The cost of associated HAC has also reduced by 29 % (from $1,282,748 to $911,117) as well as the mean length stay by 11 % (from 18 days to 16 days) post the intervention phase. This study highlights that well-designed electronic prescribing alerts that provide context-relevant information to prescribers are likely to result in benefits to clinicians and patients as well reduction in economic burden. Moreover, they could also contribute to reducing hospital acquired complications and lessen the economic burden on our society.

中文翻译:

重新设计计算机决策支持系统以改进非维生素 K 口服抗凝药处方——前后定性和定量研究

不恰当的非维生素 K 制剂 (NOAC) 处方会给我们的社会带来重大的经济和个人负担。研究表明,如果设计得当且有针对性,计算机化警报可以有效改善处方,而不会导致警报疲劳。成立了一个多学科协作审查小组来审查和批准医院电子药物管理系统(EMS)的升级和修改。干预措施的重点是实施 EMS 中内置的定制电子患者特定生理警报(例如年龄、肾功能体重和药物相互作用),以提高这家澳大利亚多站点教学医院 NOAC 处方的适当性。为了评估干预措施的定性和定量影响,在澳大利亚一家拥有 650 个床位的多地点医院中,对 100 名患者实施前和实施后的 NOAC 处方进行了前后回顾性研究。NOAC 处方的适当性由经验丰富的药剂师使用经批准的处方产品信息建议进行评估。在研究的两个阶段均使用标准满意度调查来评估处方者满意度和体验调查。对可能存在不适当 NOAC 处方的相关医院获得性并发症 (HAC) 以及相关入院费用和平均住院时间进行了评估。EMS 中计算机决策支持的重新设计将 NOAC 处方的适当性从 48% 提高到 91%,P < 0.05。共有 67 名处方医生接受邀请参加定性满意度研究。一半受访者 (n = 33, 50%) 对评估在 EMS 中实施 NOAC 警报对于改善其实践和患者安全的有用性的问题做出了积极回答。在干预后阶段,这一比率已增加至 72% (n = 48)。P<0.05。此外,在干预后阶段,报告的可能与不适当的 NOAC 处方相关的 HAC 总数减少了 36%(从 29 例减少到 22 例(RR = 0.7454 95 %CI (0.4283−1.2972),P = 0.2986) . 相关 HAC 的成本也减少了 29%(从 1,282,748 美元到 911,117 美元),干预阶段后平均住院时间减少 11%(从 18 天减少到 16 天)。这项研究强调,精心设计的电子处方向处方者提供上下文相关信息的警报可能会给临床医生和患者带来好处,并减轻经济负担。此外,它们还可能有助于减少医院获得性并发症并减轻我们社会的经济负担。
更新日期:2021-05-31
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