Custom alert analysis
A variety of drugs triggered a risk score calculation. Table A.2 in the supplementary appendix displays the top drugs triggering risk score calculation stratified by route, risk for TdP based on CredibleMeds list, percentage of all alerts generated, the action that triggered the score calculation, and QTc prolongation associated with each drug. As mentioned earlier, the risk score calculation was generated upon signature or verification of a QTc-prolonging medication from any of the CredibleMeds lists 1, 2 or 3. Intravenous (IV) ondansetron, furosemide and diphenhydramine contributed to 13%, 11%, and 9% of the risk score calculations respectively, and ultimately, custom alerts. Based on follow up ECG review, QTc prolongation was most associated with IV haloperidol (88% of alerts triggered resulted in QTc prolongation), followed by oral methadone (71%), IV metoclopramide (38%), IV promethazine (31%), oral tramadol (25%), and IV ondansetron (25%).
A total of 172 out of 521 (33%) triggering medications were ordered to be administered on an as needed basis (PRN). The top PRN medications including percentage of alerts generated and QTc prolongation are shown in table A.3 in the supplementary appendix. However, data on the number of doses administered was not collected as this was not within the scope and timeline of our project.