Key result
Targeted electronic alerts for QT-prolonging drugs prompt providers to cancel ~47% of orders.
Why the study?
Hospitalized patients have a high prevalence of prolonged QTc and are at high risk for Torsades de Pointes, with QT prolonging drugs as a modifiable risk factor.
Cohort (n=6,453)
Yes
Targeted alerts may reduce QT-prolonging prescriptions in high-risk inpatients; leaves open effects on TdP incidence or mortality.
Hospitalized patients have a high prevalence of prolonged QTc and are a high-risk population for Torsades de Pointes (TdP). One modifiable risk factor for TdP is the use of QT prolonging drugs. Electronically alerting providers who are ordering QT prolonging drugs in at-risk patients may help to achieve safer prescribing practices. Our previous study decreased inappropriate prescription of IV haloperidol by 36% using a targeted "smart" electronic alert. We wanted to assess an approach to expanding this type of electronic alert to commonly used QT prolonging medications and evaluate how this would affect prescribing practice. This retrospective cohort study evaluated the impact of these alerts for 12 frequently prescribed high-risk medications across a major health system. Between October 2016 and June 2017, a total of 6453 alerts fired and resulted in 3020 (46.8%) orders being cancelled by the provider. Our focused electronic alert significantly decreased prescribing of QT prolonging medications in high-risk patients.
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Cumbler et al. (2018) conducted a cohort in Prolonged QTc and risk of Torsades de Pointes (n=6,453). Targeted electronic alerts for QT prolonging medications was evaluated on Order cancellation by the provider. Targeted electronic alerts for 12 high-risk QT prolonging medications in hospitalized patients resulted in 46.8% (3,020 of 6,453) of orders being cancelled by providers.
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