title: Using an electronic clinical decision support system to reduce the risk of epidural hematoma.
abstract: Epidural hematoma is a major complication that can occur when neuraxial anesthesia is used concurrently with newer anticoagulation and antiplatelet medications. In complex hospital environments, the opportunity of performing a neuraxial procedure in an anticoagulated patient or starting potent anticoagulants on a patient with existing epidural catheter still exists. We describe a technique to use an electronic clinical decision support ordering system that helps reduce this risk of epidural hematoma. Through a series of automated warnings that bring to light existing anticoagulant or antiplatelet medications at the time of doing the procedure or a secondary warning system to those practitioners initiating anticoagulant medications on a patient with an existing epidural, we hope to reduce the number of medication errors. Before initiating the alert system, we had 26 events noted in the medical chart over a 3-month period. We noted only 11 events after the initiation of the new alert systems and clinical decision support in a similar 3-month period. Using electronic clinical decision support systems can help reduce medication errors related to neuraxial anesthesia and anticoagulation medications in a large hospital system.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN.
authors.forename: Rajnish K
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000925:Anticoagulants / Q000627:therapeutic use; D020000:Decision Support Systems, Clinical; D006407:Hematoma, Epidural, Cranial / Q000517:prevention & control*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D012306:Risk
chemical_list: D000925:Anticoagulants