Future implications
Based on our findings and adjusted score results, we will plan to
integrate this risk score into the EHR as a guidance tool. The risk
score will be incorporated as a non-interruptive active clinical
decision support shown in the work queue or patient list, in addition to
an interruptive active clinical decision support linked to a custom
alert. We will plan to incorporate this tool for both inpatients and
outpatients, and turn off the DDI warnings. We will exclude medications
from CredibleMeds list 3 as triggers given their low risk for QTc
prolongation and their minimal contribution to our data model. In
addition, since ondansetron is very widely used at our institution due
to the need for antiemetics in our patient population, and is overridden
more than 90% of the time, an option would be to turn off the alerts
for IV and oral ondansetron. Another option would be to possibly exclude
“as needed” or “once” medications as triggers. Discussions with
various departments will be necessary to guarantee the safety and
feasibility of this process, while ensuring that the score is accurately
extracting the proper information from the EHR. Lastly, it would be
ideal to assess the volume of custom alerts a few months later to
determine whether it would serve as a replacement clinical decision
support for the current DDI warnings for QTc-prolongation in the long
term.