Stealth alerts to improve warfarin monitoring when initiating interacting medications
Journal of General Internal Medicine, 08/17/2012
Koplan KE et al. – Stealth alerts increased the proportion of patients who underwent anticoagulation monitoring following the prescription of a medication that could potentially interact with warfarin. This team–based approach to clinical–decision support directs alerts away from prescribing clinicians and toward individuals who can directly implement them.Methods
- Authors conducted a pre–post intervention study, analyzed using an interrupted time–series, within a large, multispecialty group practice that uses a common EHR.
- The study included a 12–month period preceding the intervention, a 2–month period during intervention implementation, and a 6–month post–intervention period.
- The primary outcome measure was the proportion of patients completing anticoagulation monitoring within 5 days of a new co–prescribing event.
- Prior to implementation of the stealth alert, 34 % of patients completed anticoagulation monitoring within 5 days after the prescription of a medication with a potential warfarin interaction.
- After implementation of the alert, 39 % completed testing within 5 days (odds ratio 1.24, 95 % confidence interval 1.12–1.37).