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.