title: A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring.
abstract: We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatient serum AED levels during two 3-month periods were included in the study. During the 3-month period after implementation of the automated intervention, 13% of all AED tests ordered were canceled following computerized reminders. For orders appearing redundant, the cancellation rate was 27%. For nonredundant orders, 4% were canceled when information on specific AED monitoring and pharmacokinetics was provided. The cancellation rate was sustained after 4 years. There has been a 19.5% decrease in total AED testing volume since implementation of this intervention, despite a 19.3% increase in overall chemistry test volume. Inappropriateness owing to repeated testing before pharmacologic steady state was reached decreased from 54% of all AED orders to 14.6%. A simple, automated, activity-based intervention targeting a specific test-ordering behavior effectively reduced inappropriate laboratory testing. The sustained benefit supports the idea that computerized interventions may durably affect physician behavior. Computerized delivery of such evidence-based boundary guidelines can help narrow the gap between evidence and practice.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Chen
authors.forename: Milenko J
authors.initials: MJ
authors.lastname: Tanasijevic
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Schoenenberger
authors.forename: Julie
authors.initials: J
authors.lastname: Fiskio
authors.forename: Gilad J
authors.initials: GJ
authors.lastname: Kuperman
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000465:Algorithms; D000927:Anticonvulsants / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019985:Benchmarking; D016303:Clinical Pharmacy Information Systems; D016903:Drug Monitoring / Q000379:methods*; D011307:Drug Prescriptions; D004360:Drug Therapy, Computer-Assisted; D019317:Evidence-Based Medicine / Q000379:methods; D006287:Health Planning Guidelines; D006784:Hospitals, Teaching; D006801:Humans; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D017010:Reminder Systems; D019564:Unnecessary Procedures
chemical_list: D000927:Anticonvulsants