title: Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes.
abstract: We developed and implemented a 'CPOE-QT Alert' system, that is, clinical decision support integrated in the computerized physician order entry system (CPOE), in 2011. The system identifies any attempts to order medications with risk of torsade de pointes (TdP) for patients with a history of significant QT prolongation (QTc ≥500 ms) and alerts the provider entering the order. We assessed its impact by comparing orders and subsequent medication administration before and after activation of the system. We found a significant decrease in the proportion of completed order per ordering attempt after system activation (94% (1293/1379) vs 77% (1888/2453), difference 16.8%; p<0.001). This resulted in a 13.9% reduction in the administration of those medications to patients. A significant decrease was observed across all provider types, educational levels, and specialties. The CPOE-QT Alert system successfully reduced exposure to QT-prolonging medications in high risk patients.
authors.affiliation: Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sorita
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: J Martijn
authors.initials: JM
authors.lastname: Bos
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Morlan
authors.affiliation: Division of Biostatistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tarrell
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Caraballo
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications / Q000188:drug therapy; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D012307:Risk Factors; D016171:Torsades de Pointes / Q000517:prevention & control*
keywords: QT prolongation; clinical decision support; computerized physician order entry; medication management; torsade de pointes