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Impact of workflow-integrated corollary orders on aminoglycoside monitoring in childrenDivision of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Center for Health Policy and Clinical Effectiveness, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229, USA, Jacobs{at}chmcc.org Clinical Informatics Outcomes Research Group Computerized provider order entry (CPOE) and clinical decision support improve medication prescribing safety in adults. However, effective therapy for children requires dosing based on circulating medication levels. We examined the introduction of a computerized corollary order for aminoglycoside blood level monitoring. The study was divided into baseline (BP) and corollary order (CP) periods. In the CP, we implemented a workflow-integrated reminder to order blood levels and presented this to the clinician during each aminoglycoside ordering session. Appropriate laboratory monitoring was 128/159 (80.5%) courses in the BP and 146/177 (82.5%) courses in the CP. Thus introduction of the order did not significantly improve laboratory monitoring rates, nor did it result in a reduction in the rate of either toxic or subtherapeutic levels. However, aminoglycoside corollary orders may have an important role in institutions where pharmacists are not actively involved in monitoring therapy.
Key Words: aminoglycosides • antibiotics • clinical decision support • corollary order • computerized provider order entry • medication safety
Health Informatics Journal, Vol. 12, No. 3,
187-198 (2006) |
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