CDS tools can improve prescribing for kidney disease patients

Medication alerts can improve the accuracy and safety of prescribing drugs to patients with impaired renal function, according to a study published recently in the Journal of the American Medical Informatics Association (JAMIA).

As with patients with other chronic conditions, those with kidney issues are at risk if they receiving improper medications or inaccurate amounts of them. The researchers, from the San Diego School of Medicine and elsewhere, developed a clinical decision support (CDS) tool for 20 medications in a commercial electronic health record. The tool detected scenarios where drug discontinuation or drug adjustment was recommended for adult patients with impaired renal function in ambulatory and acute care settings, both when the drug was initially prescribed (a "prospective" alert) and by monitoring changes in renal function for patients already receiving medications (a "lookback" alert).

There were a total of 4,068 triggering conditions in 1,278 unique patients; 1,579 of the trigger alerts represented patients seen by physicians in the intervention arm of the study; the rest were captured but suppressed to not generate alerts in the control arm. 

The researchers found that 17 percent of the prescribing orders were adjusted when an alert was triggered compared to just 5.7 percent of the orders in the control group. The prospective alerts had a greater impact than the look back ones.

"The rate of appropriate drug prescribing in kidney impairment is low and remains a patient safety concern," the researchers said. "Our results suggest that CDS improves drug prescribing, particularly when providing guidance on new prescriptions."

Evidence continues to mount in favor of CDS in EHRs, pinpointing issues that may otherwise be overlooked and improving patient care. However, they are most effective when they're reasonable in frequency and customized or redesigned to best meet clinicians' needs. Unnecessary and clinically inconsequential alerts, on the other hand, increase providers' burdens, contribute to "alert fatigue" and tend to get overridden.

To learn more:
- here's the abstract