title: Computerized physician order entry-based system to prevent HBV reactivation in patients treated with biologic agents: the PRESCRIB project.
abstract: Computerized physician order entry (CPOE) applications are widely used to prevent medical errors. In our center, a CPOE system has been in use since 2009 on both the inpatient and outpatient levels. A new and simple alert was introduced in the CPOE system to notify healthcare providers of the potential risk of viral reactivation when prescribing biological therapies, thereby facilitating the request for a serological profile (hepatitis B surface antigen [HBsAg], anti-HBc, and anti-HBs) in patients who have not had these tests. Between May 2012 and May 2013, a total of 1,076 patients undergoing biological treatment were included in the implementation of the CPOE in our hospital, resulting in the identification of 4 HBsAg-positive and 69 anti-HBc-positive/HBsAg-negative patients, two of them with positive viral loads. Since the implementation of this alert system, over 90% of patients who were prescribed a biological drug (BD) have undergone serological screening to detect hepatitis B virus (HBV) infection. The use of the alert system has increased the screening rate from less than 50% to 94% for HBsAg and from less than 30% to 85% for anti-HBc in patients for whom a BD is prescribed. Six patients received prophylactic antiviral therapy. No patient had HBV reactivation.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of implementing a CPOE system that has allowed our hospital to increase the rate of HBV screening. Its use has facilitated the identification of patients at high risk for HBV reactivation and permitted physicians to prescribe prophylactic measures according to current guidelines.
authors.affiliation: Gastroenterology and Hepatology Unit, Marqués de Valdecilla University Hospital, Spain; Gastroenterology Department, Galdakao Hospital, Bizkaia, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Sampedro
authors.forename: Cándido
authors.initials: C
authors.lastname: Hernández-López
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Ferrandiz
authors.forename: Aitziber
authors.initials: A
authors.lastname: Illaro
authors.forename: Emilio
authors.initials: E
authors.lastname: Fábrega
authors.forename: Antonio
authors.initials: A
authors.lastname: Cuadrado
authors.forename: Paula
authors.initials: P
authors.lastname: Iruzubieta
authors.forename: Susana
authors.initials: S
authors.lastname: Menéndez
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cabezas
authors.forename: Javier
authors.initials: J
authors.lastname: Crespo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D001685:Biological Factors / Q000009:adverse effects*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011446:Prospective Studies; D012307:Risk Factors; D014775:Virus Activation / Q000187:drug effects* / Q000276:immunology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D001685:Biological Factors; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents