Electronic medication alerts can help physicians more accurately and safely prescribe medications to patients with kidney disease, according to a study published in the Journal of the American Medical Informatics Association, FierceEMR reports.

Background

According to FierceEMR, patients with kidney disease are at risk if they receive the wrong medications or inaccurate medication doses (Durben Hirsch, FierceEMR, 11/30).  The study authors, which included researchers from the University of California-San Diego, the University of Southern California and the Northeast Georgia Diagnostic Clinic, noted that the "rate of appropriate drug prescribing in kidney impairment is low and remains a patient safety concern" (Awdishu et al., JAMIA, 11/28).

Study Details

For the study, the researchers sought to determine whether a clinical decision support tool could be effectively used to improve prescribing for patients with kidney disease.

They developed a clinical decision support tool for 20 medications in a commercial electronic health record system to identify situations in which drug adjustment or discontinuation was recommended for adults with impaired renal function in both ambulatory and acute care settings.

The tool issued two types of alerts, a:

• Prospective alert when the drug was initially prescribed; and
• Lookback alert which monitored changes in renal functions for patients already receiving medications (FierceEMR, 11/30).  

Study Findings

According to the study, a total of 4,068 triggering conditions occurred in 1,278 unique patients, of which:

• 1,579 of the alerts were seen by physicians in the intervention group; and
• 2,489 of the alerts were triggered but suppressed so the alerts were not generated for physicians in the control group (JAMIA, 11/28).

The researchers found that 17% of prescribing orders were appropriately adjusted when an alert was triggered in the intervention group, compared with 5.7% of orders in the control group.

In addition, the researchers found that the prospective alerts had a greater effect than lookback alerts.

Researchers wrote, "Our results suggest that [clinical decision support] improves drug prescribing, particularly when providing guidance on new prescriptions" (FierceEMR, 11/30).