Real Time Applied Therapeutics in the Critical Care Environment: Role of a Data Mining Clinical Decision Support Tool

Abstract

SESSION TITLE: Critical Care in the ICU SESSION TYPE: Original Investigation Poster Discussion PRESENTED ON: Monday, October 24, 2016 at 12:00 PM - 01:30 PM PURPOSE: Real time drug therapy optimization, with minimal adversities is essential in the critical care environment. Clinical Decision Support System (CDSS), an electronic clinical surveillance system is a data mining tools which feed real-time ADT (Admission, Discharge, and Transfer) laboratory, pharmacy, radiology, and surgery data. The system processes these data, based on pre-defined rules to detect changes in patients’ conditions in real-time, then flags clinical alerts. Real-time critical alerts can be utilized by physicians and pharmacists in optimizing care and minimizing adverse events. METHODS: In the intensive care units, the clinical pharmacy team acknowledged CDSS alerts, consulted with the medical team or used exiting protocols, to modify drug therapies, based on various clinical parameters. Approval for the study was obtained from the IRB. February 2016 alerts, flagged by CDSS, in the Critical Care Units, were evaluated, based on thirty-six intervention categories (Antimicrobial therapy (13), Adverse Drug Event (10), Anticoagulation Dosing Consults (1), Drug Regimen Modification (9), High Cost (1), Intravenous to Oral Therapy Conversion (1), and Renal Dosing Adjustment (1). RESULTS: In February 2016, CDSS fired 7557 (1717 Critical Care Unit) alerts, with 100% acknowledged, by the clinical pharmacy team, at Corpus Christi Medical Center. These alerts resulted in 15057 associated categorized interventions; 2995 in the critical care units. The outcome of these 2995 documentations in the critical care units were as follow: 1685 (appropriate with no action necessary), 791 (drug therapy modifications occurred), 299 (expired / patient discharges), 104 (non-drug interventions), 88 (associated activations), 14 (rejected recommendations), 11 (follow-ups), 2(CDSS rules requiring adjustments), and 1 (consult). Top 10 intervention categories were as follows: Evidence of infection and antimicrobial therapy warranted (634), Adverse drug event - glycemic control (270), Renal dosage adjustment (250), Intravenous to oral therapy conversion (226), Intravenous to oral antimicrobial therapy conversion (208), Renal dosage adjustment - antimicrobial therapy (145), Drug regimen modification - added therapy (136), Adverse drug event - anticoagulation (120), Drug regimen modification - glycemic control (117), Adverse drug event -rescue medication (102). Numbers of interventions for top 10 drugs were: famotidine (173), enoxaparin (149), pantoprazole (106), azithromycin (91), levofloxacin (85), digoxin (62), piperacillin/tazobactam (48), fluconazole (45), vancomycin (42), and cefazolin (41). CONCLUSIONS: CDSS in the critical care environment is being effectively used to optimize therapy, minimize adverse events, and, reduce costs in real time. CLINICAL IMPLICATIONS: CDSS is an effective and valuable tool in applied therapeutics, within the critical care environment. Its employment in this arena can save lives, prevents medication misadventures, and associated morbidities. DISCLOSURE: The following authors have nothing to disclose: George Udeani, Nana Akuffo, John Evans, Salim Surani, Joseph High No Product/Research Disclosure Information