title: Don't fuel the fire: decreasing intravenous haloperidol use in high risk patients via a customized electronic alert.
abstract: Delivering useful clinical decision support to providers who are ordering high risk drugs for high risk patients is imperative for safe pharmacotherapy. This paper presents a focused electronic clinical decision support intervention designed to decrease the risk of corrected QT interval (QTc) related adverse drug events in a high risk patient population. Results showed that a customized alert can both decrease the number of alerts sent to providers while still improving the safety of prescribing practices for intravenous haloperidol. The alert leveraged components of the electronic health record to significantly decrease the rate of inappropriate prescription of intravenous haloperidol in patients with QTc >500 ms from 50% to 14%. The results also suggest providers may abandon the appropriate prescription of a medication in response to an alert. The findings support the necessity of careful targeting of electronic alerts and monitoring for unintended consequences when implementing these types of electronic alerts.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Colorado Denver, School of Medicine, Aurora, Colorado, USA.
authors.forename: Jonathan Michael
authors.initials: JM
authors.lastname: Pell
authors.affiliation: Department of Internal Medicine, University of Colorado Hospital, Aurora, Colorado, USA.
authors.forename: Dora
authors.initials: D
authors.lastname: Cheung
authors.affiliation: University of Colorado Hospital, Aurora, Colorado, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jones
authors.affiliation: Division of General Internal Medicine, Hospital Medicine Group, University of Colorado Hospital, Aurora, Colorado, USA.
authors.forename: Ethan
authors.initials: E
authors.lastname: Cumbler
mesh_terms: D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D006220:Haloperidol / Q000008:administration & dosage*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000639:trends; D007262:Infusions, Intravenous; D050316:Medical Order Entry Systems; D056687:Off-Label Use; D010818:Practice Patterns, Physicians'; D017010:Reminder Systems; D012306:Risk
chemical_list: D006220:Haloperidol