- The use of clinical analytics and EHR alerts to identify potential adverse drug events helped Marshfield Clinic cut down on nearly 80 percent of possible instances where a prescription may have caused patient harm, finds a study published this month in the Journal of Managed Care & Specialty Pharmacy.
By leveraging clinical analytics to weight the potential seriousness of a drug interaction and deliver smart notifications to providers through the EHR, Marshfield researchers were able to examine best practices for avoiding alarm fatigue and ensuring patient safety in an accountable care organization environment.
“A goal of this project was to partner with the prescriber in the overall care of the patient,” said Sara Griesbach, PharmD, BCPS, BCACP, director of clinical pharmacy services at Marshfield Clinic, who helped lead the study. “This program was created to identify drug alerts with potential to impact a large patient population that may require intervention to decrease the risk for adverse drug events.”
During the first twelve months of the program, researchers flagged six common medications that were often involved in potential adverse drug events (pADE), including topiramate, glyburide, simvastatin, citalopram, pioglitazone, and lovastatin. Using internal baseline data from before the program, pulled from electronic health records, the team identified around 10,000 pADEs involving contraindications, incorrect dosages, severe side effects, and other patient safety concerns that revolved around these medications.
In order to prevent the clinic from overwhelming clinicians with electronic alerts and risking the type of alarm fatigue that consistently makes national lists of top patient safety and provider satisfaction concerns, Marshfield decided to use clinical analytics to mine EHR data and develop a prioritized notification system. The system is based on an algorithm that determines which pADEs require an immediate stop-action notification within the EHR workflow, and which can be included in a color-coded daily report that covers all of a clinician’s patients prescribed a certain medication.
“This critical aspect of the clinic’s Drug Safety Alert Program (DSAP) ensures that providers are only given the information they need and encourages them to integrate the alerts into their care plans,” the study says, but acknowledges that these alerts cannot be delivered in real-time, and cannot fully cover patients who may be receiving treatment concurrently at other facilities or organizations not included in Marshfield’s EHR data system.
The scoring system is based on the potential severity of the pADE and the content of the alert, whether it is an educational advisement or a warning to change a certain treatment protocol, the researchers explain. “The product of the weight and the scoring level provides an individual score for each criterion, which are combined for the overall score,” says the study. “Scores of 80% or greater result in directed communication and a drug safety alert letter that is sent to the prescriber with a patient list.”
“Scores between 70% and 79% often result in a general communication to prescribers who commonly prescribe the medication. Scores of less than 70% result in no direct intervention at that time, but close evaluation and follow-up. The scoring criteria, weighted score, and intended results are routinely reviewed and updated when necessary.”
The EHR-based alerts helped to prompt prescription changes that resolved more than 8000 of the 10,000 pADEs highlighted by the program, the study concludes. The other 2000 incidences may include judicious override of the alert when the benefits of the prescription were greater than the risks, or personnel issues that the clinic will continue to monitor. While financial savings have not yet been measured, the set-up costs for the highly successful program were limited mostly to making electronic prescribing data available to the clinical analytics data warehouse, the researchers added.
”This study highlights the critical role that health information technologies play in ensuring safe and appropriate use of medications in an ACO environment,” said NPC Executive Vice President and Chief Science Officer Robert W. Dubois, MD, PhD, who is a study co-author.