Computer alerts for potassium testing: resisting the temptation of a blanket approach

Abstract

In the Nov/Dec, 2003 issue of JAMIA , Hoch et al1 have reported the effectiveness of computer alerts to improve potassium testing in patients receiving diuretics. The underlying hypothesis of the study was that diuretics can cause hypokalemia, which can lead to adverse drug events (ADEs) including atrial and ventricular arrhythmias. The authors suggest that computer alerts to physicians would increase the rate of annual potassium testing for patients on diuretics, which would, in turn, prevent such ADEs. However, we wish to draw readers' attention to the following details. First, it is conceivable that physicians deliberately decided not to test their patients annually based on their clinical judgment. The patients might have had stable serum potassium levels for many years or may have been asked to follow a high-potassium diet. Hence, the physicians may have changed behavior to avoid repeat alerts and not solely on …