Effect of Replacing Vendor QTc Alerts with a Custom QTc Risk Alert in Inpatients

2022 ◽  
Vol 13 (01) ◽  
pp. 019-029
Author(s):  
Steven Stettner ◽  
Sarah Adie ◽  
Sarah Hanigan ◽  
Michael Thomas ◽  
Kristen Pogue ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Clinical Decision ◽  
Qtc Interval ◽  
Intervention Period ◽  
Qtc Prolongation ◽  
Post Intervention ◽  
Medication Knowledge ◽  
Quasi Experimental ◽  
Risk Scoring ◽  
Scoring Tool

Abstract Objective The aim of the study is to implement a customized QTc interval clinical decision support (CDS) alert strategy in our electronic health record for hospitalized patients and aimed at providers with the following objectives: minimize QTc prolongation, minimize exposure to QTc prolonging medications, and decrease overall QTc-related alerts. A strategy that was based on the validated QTc risk scoring tool and replacing medication knowledge vendor alerts with custom QTc prolongation alerts was implemented. Methods This is a retrospective quasi-experimental study with a pre-intervention period (August 2019 to October 2019) and post-intervention period (December 2019 to February 2020). The custom alert was implemented in November 2019. Results In the pre-implementation group, 361 (19.3%) patients developed QTc prolongation, and in the post-implementation group, 357 (19.6%) patients developed QTc prolongation (OR: 1.02, 95% CI: 0.87–1.20, p = 0.81). The odds ratio of an action taken post-implementation compared with pre-implementation was 18.90 (95% CI: 14.03–25.47, p <0. 001). There was also a decrease in total orders for QTc prolonging medications from 7,921 (5.5%) to 7,566 (5.3%) with an odds ratio of 0.96 (95% CI: 0.93–0.99, p = 0.01). Conclusion We were able to decrease patient exposure to QTc prolonging medications while not increasing the rate of QTc prolongation as well as improving alert action rate. Additionally, there was a decrease in QTc prolonging medication orders which illustrates the benefit of using a validated risk score with a customized CDS approach compared with a traditional vendor-based strategy. Further research is needed to confirm if an approach implemented at our organization can reduce QTc prolongation rates.

Drug-Induced QTc Prolongation: What We Know and Where We Are Going

2021 ◽  
Vol 16 ◽  
Author(s):  
Erinn Mangona ◽  
Elisa Sandonato ◽  
Todd N. Brothers ◽  
Jayne Pawasauskas
Keyword(s):  
Torsades De Pointes ◽  
Clinical Decision ◽  
Mitigation Strategies ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Drug Classes ◽  
Malignant Arrhythmia ◽  
Alternative Agent ◽  
Risk Scoring ◽  
Scoring Tool

: Drug-induced QTc prolongation is a concerning electrocardiogram (ECG) abnormality. This cardiac disturbance carries a 10% risk of sudden cardiac death due to the malignant arrhythmia, Torsades de Pointes. The Arizona Center for Education and Research on Therapeutics (AzCERT) has classified QTc prolonging therapeutic classes such as antiarrhythmics, antipsychotics, anti-infectives, and others. AzCERT criteria categorizes medications into three risk categories: “known,” “possible,” and “conditional risk” of QTc prolongation and Torsades de Pointes. The list of QTc prolonging medications continues to expand as new drug classes are approved and studied. Risk factors for QTc prolongation can be delineated into modifiable or non-modifiable. A validated risk scoring tool may be utilized to predict the likelihood of prolongation in patients receiving AzCERT classified medication. The resultant risk score may be applied to a clinical decision support system which offers mitigation strategies. Mitigation strategies including discontinuation of possible offending agents with selection of an alternative agent, assessment of potential drug interactions or dose adjustments through pharmacokinetic and pharmacodynamic monitoring, and initiation of both ECG and electrolyte monitoring are essential to prevent a drug-induced arrhythmia. The challenges presented by the COVID-19 pandemic have led to the development of innovative continuous monitoring technology, increasing protection for both patients and healthcare workers. Early intervention strategies may reduce adverse events and improve clinical outcomes in patients identified to be at risk of QTc prolongation.

scholarly journals Quality of the documentation of the Nursing process in clinical decision support systems

2021 ◽  
Vol 29 ◽  
Author(s):  
Neurilene Batista de Oliveira ◽  
Heloísa Helena Ciqueto Peres
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Nursing Process ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Process Documentation

Objective: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. Method: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. Results: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. Conclusion: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.

Using Signage to Promote Stair Use on a University Campus in Hidden and Visible Stairwells

2010 ◽  
Vol 7 (2) ◽  
pp. 232-238 ◽  
Author(s):  
Megan E. Grimstvedt ◽  
Jacqueline Kerr ◽  
Sara B. Oswalt ◽  
Donovan L. Fogt ◽  
Tiffanye M. Vargas-Tonsing ◽  
...  
Keyword(s):  
San Antonio ◽  
University Campus ◽  
Intervention Period ◽  
Post Intervention ◽  
Promotion Strategy ◽  
Quasi Experimental ◽  
University Buildings ◽  
Stair Use ◽  
Experimental Study Design

Background:This study tested the effectiveness of a stair use promotion strategy in visible and hidden stairwells during intervention and post intervention follow up.Methods:A quasi-experimental study design was used with a 1 week baseline, a 3 week intervention, and post intervention at 2 and 4 weeks in 4 university buildings in San Antonio, Texas with stairwells varying in visibility. Participants were students, faculty, staff, and visitors to the 4 buildings. A total of 8431 observations were made. The intervention incorporated motivational signs with direction to nearby stairwells placed by elevators to promote stair use. Stair and elevator use was directly observed and recorded. Logistic regression analyses were used to test whether stair versus elevator use varied by intervention phase and stairwell visibility.Results:Stair use increased significantly (12% units) during the intervention period and remained above baseline levels during post intervention follow-up. At baseline, visible stairs were 4 times more likely to be used than hidden stairs; however, the increase in stair use during intervention was similar in both types of stairwells.Conclusions:Motivational and directional signage can significantly increase stair use on a university campus. Furthermore, stairwell visibility is an important aspect of stair use promotion.

scholarly journals ADESÃO ÀS MEDIDAS PARA PREVENÇÃO DA INFECÇÃO DA CORRENTE SANGUÍNEA RELACIONADA AO CATETER VENOSO CENTRAL

2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Alanna Gomes Da Silva ◽  
Adriana Cristina De Oliveira
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Descriptive Statistics ◽  
Intervention Period ◽  
Central Venous ◽  
Post Intervention ◽  
Period Analysis ◽  
Quasi Experimental ◽  
Terapia Intensiva

Objetivo: verificar a adesão da equipe multiprofissional para as medidas de prevenção da infecção da corrente sanguínea relacionada ao cateter venoso central. Metodologia: estudo quase-experimental, realizado na unidade de terapia intensiva de um hospital de urgência e emergência. A população foi composta pelas equipes médicas e de enfermagem. A coleta de dados ocorreu em três fases distintas: Período pré-intervenção, Período de intervenção e Período pós-intervenção. As análises foram por meio de estatística descritiva e pelos testes ?² de Pearson e exato de Fisher. Resultados: verificou-se uma baixa adesão global pelos enfermeiros e técnicos, especialmente à higiene das mãos (22,7%) e desinfecção do hub (10,4%) e uma adesão de 100% da equipe médica ao utilizar a barreira máxima de precaução. Conclusão: mesmo com um resultado satisfatório para a inserção dos cateteres nos períodos pré e pós-intervenção, essas medidas não representam completa adesão pela equipe de enfermagem.Descritores: Infecções Relacionadas a Cateter, Unidades de Terapia Intensiva, Cateteres Venosos Centrais.ADHERENCE TO MEASURES TO PREVENT BLOODSTREAM INFECTION RELATED TO THE CENTRAL VENOUS CATHETERObjective: To verify the multiprofessional staff adherence to measures to prevent bloodstream infection related to the central venous catheter. Methodology: A quasi-experimental study, carried out at an intensive care unit from emergency and urgency hospital. The population was composed by medical and nursing staff. Data collection took place in three distinct phases: Pre-intervention period, intervention period and post-intervention period. Analysis were made through descriptive statistics and Pearson’s ?² and Fisher’s exact tests. Results: There was a low overall adherence by nurses and technicians, especially to hand hygiene (22.7%) and hub disinfection (10.4%), and a 100% adherence from medical staff when using the maximum barrier of precaution. Conclusion: Even with a satisfactory result for catheters insertion in the pre-and post-intervention periods, these measures are not enough when the catheter maintenance measures are not fully adhered by the nursing team.Descriptors: Catheter-Related Infections, Intensive Care Units, Central Venous Catheters.ADHESIÓN PARA LA PREVENCIÓN DE INFECCIÓN DEL TORRENTE SANGUÍNEO RELACIONADAS CON EL CATÉTER VENOSO CENTRALObjetivo: Determinar la adhesión de miembros del equipo multiprofesional para la prevención de infección del torrente sanguíneo relacionadas con el catéter venoso central. Metodología: Estudio cuasi-experimental realizado en una unidad de cuidados intensivos de un hospital de emergencia y urgencia. La población estaba compuesta por el personal médico y de enfermería. La recolección de datos ocurrió en tres fases: periodo previo a la intervención; Período de intervención y después de la intervención. Los análisis fueron hechos por la estadística descriptiva y las pruebas de ?² de Pearson y la prueba exacta de Fisher. Resultados: Se observó una baja de miembros en general por las enfermeras y los técnicos, especialmente higiene de las manos (22,7%) y la desinfección del hub (10,4%) y una membresía de 100% del personal médico usando la barrera máximo precaución. Conclusión: Incluso con un resultado satisfactorio para la inserción de catéteres en el pre y post-intervención, estas medidas no son suficientes cuando las medidas para el mantenimiento de los catéteres no se cumplen por completo por el personal de enfermería.Descriptores: Infecciones Relacionadas con Catéteres, Unidades de Cuidados Intensivos, Catéteres Venosos Centrales.

scholarly journals Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L. Paul ◽  
John R. Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Post Treatment ◽  
Trial Registration ◽  
Control Group ◽  
Intervention Period ◽  
Post Intervention ◽  
Individual Level ◽  
Post Intervention Period

Abstract Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia. Methods A posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0–2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5–6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups. Results There was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52). Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage. Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

scholarly journals The Effect of Regimen Frequency Simplification on Provider Order Generation: A Quasi-Experimental Study in a Korean Hospital

2021 ◽  
Vol 18 (8) ◽  
pp. 4086
Author(s):  
Jungwon Cho ◽  
Sangmi Shin ◽  
Young Mi Jeong ◽  
Eunsook Lee ◽  
Euni Lee
Keyword(s):  
Care Service ◽  
Health Care Service ◽  
Intervention Period ◽  
Post Intervention ◽  
Test Study ◽  
Post Test ◽  
Quasi Experimental ◽  
Simple Change ◽  
Team Project ◽  
Physician Order Entry

The multiplicity of dosing frequencies that are attached to medication orders poses a challenge to patients regarding adhering to their medication regimens and healthcare professionals in maximizing the efficiencies of health care service delivery. A multidisciplinary team project was performed to simplify medication regimens to improve the computerized physician order entry (CPOE) system to reduce the dosing frequencies for patients who were discharged from the hospital. A 36-month pre-test–post-test study was performed, including 12-month pre-intervention, 12-month intervention, and 12-month post-intervention periods. Two-pronged strategies, including regimen standardization and prioritization, were devised to evaluate the dosing frequencies and prescribing efficiency. The results showed that the standardized menu reduced the dosing frequencies from 4.3 ± 2.2 per day in the pre-intervention period to 3.5 ± 1.8 per day in the post-intervention period (p < 0.001). In addition, the proportion of patients taking medications five or more times per day decreased from 40.8% to 20.7% (p < 0.001). After prioritizing the CPOE dosing regimen, the number of pull-down options that were available reflected an improvement in the prescribing efficiency. Our findings indicate that concerted efforts in improving even a simple change on the CPOE screen via standardization and prioritization simplified the dosing frequencies for patients and improved the physicians’ prescribing process.

scholarly journals Thrombolysis implementation intervention and clinical outcome: A Secondary analysis of a cluster randomized trial.

2020 ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Post Treatment ◽  
Control Group ◽  
Intervention Period ◽  
Poor Clinical Outcome ◽  
Post Intervention ◽  
Individual Level ◽  
Post Intervention Period

Abstract BackgroundMultiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia.MethodsA posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0-2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5-6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups.ResultsThere was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73-3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73-2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56-2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61-3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21-1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36-2.52).ConclusionThe TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage.Trial registrationClinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

scholarly journals Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: a hospital-based quasi-experimental study

2020 ◽  
Vol 9 (4) ◽  
Author(s):  
Wit Wichaidit ◽  
Sommanas Naknual ◽  
Nanta Kleangkert ◽  
Tippawan Liabsuetrakul
Keyword(s):  
Experimental Study ◽  
Hand Hygiene ◽  
Tertiary Hospital ◽  
Pathogen Transmission ◽  
P Value ◽  
Intervention Period ◽  
Post Intervention ◽  
Observation Area ◽  
Before And After ◽  
Quasi Experimental

We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the post-intervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general.

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

2021 ◽  
pp. 089719002199700
Author(s):  
Brian C. Bohn ◽  
Elizabeth A. Neuner ◽  
Vasilios Athans ◽  
Kaitlyn R. Rivard ◽  
Allison R. Riffle ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Academic Medical ◽  
Quasi Experimental ◽  
Prospective Audit And Feedback

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.

scholarly journals Thrombolysis Implementation Intervention and Clinical Outcome: A Secondary Analysis of a Cluster Randomized Trial.

2020 ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Intervention Period ◽  
Poor Clinical Outcome ◽  
Post Intervention ◽  
Lower Odds ◽  
Individual Level ◽  
Post Intervention Period

Abstract Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia.Methods A posthoc analysis was conducted using individual-level patient data. Excellent and poor clinical outcome and parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups.Results There was a non-significantly higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significantly lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52).Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage.Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

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