Clinical Decision Support April 2015
April 18, 2015, 1500-1530 hours CST
| Attendees | ||
|---|---|---|
| Don Aaronson (Lutheran General) | Sally Garrett (Pharmacy Informatics) | LaTonya Malone (Good Samaritan) |
| KC Calderone (Good Shepherd) | Anupam Goel (Clinical Informatics) | Charles Majewski (CareConnection Core) |
| Bill Forslev (Pharmacy) | Cheryl Hager (Christ) | Kent Nelson (Children's, Oak Lawn) |
| Mary Gagen (Systems Quality) | Christopher Jamerson (Children's, Park Ridge) |
PowerPlan layout
The group reviewed the traditional and proposed format for PowerPlans. They agreed to move forward with the proposed PowerPlan layout that lists the medications, laboratory tests and radiology tests earlier in the PowerPlan.
New requests
Alert for prior echocardiograms
Cheryl spoke on behalf on Christ. There are significant patient throughput challenges for patients who are admitted for congestive heart failure but are not being discharged pending an echocardiogram. In many cases, the patient already has an echocardiogram performed within the last 12 months.
The request is to have an alert fire when a user places an order for an echocardiogram that displays the results of the last echocardiogram if it was performed in the last 12 months.
Reason for not switching to warfarin
Bill spoke on behalf of the Christ pharmacists. Many patients are falling out on quality measures when IV heparin or SQ Lovenox (therapeutic dose) is being discontinued without transitioning to an oral agent or documenting a reason why the patient should not be on long-term oral anticoagulation.
The request is to have an alert fire when IV heparin or SQ Lovenox (therapeutic dose) is discontinued with a prompt for a discontinuation reason patient not a candidate for this anticoagulation therapy.
[]Neethu to investigate if we can fire an alert or a rule upon discontinuing a medication.
Alert for PowerPlan in a planned state
A resident was able to place a PowerPlan for amiodarone in a planned state using Cerner functionality. The nurses on the floor did not activate the PowerPlan as they are conditioned to activate PowerPlans only if there is a task or an alert prompting them to do so. The task/alert build was only instituted for transitional admission PowerPlans.
The request is to have an alert fire for patients registered as observation or inpatients (not day surgery) whenever there is a planned PowerPlan on the patient's chart except chemotherapy and other oncology plans.
Avoiding accidental discontinuation of chemotherapy or other planned orders during an inpatient medication reconciliation
Many users are discontinuing medications that are part of a chemotherapy plan when performing discharge medication reconciliation because they do not realize those medications are part of the chemotherapy plan.
The request is to develop an alert or mark medication that are part of an ongoing PowerPlan differently in discharge medication reconciliation so a user would not accidentally discontinue those medications.
[] Charles will work with the medication reconciliation group within the CareConnection team to see what might be possible.
Alert prioritization
| Description | Score | Comments |
|---|---|---|
| Contrast media for patients with renal insufficiency | 17 | Prototype being developed |
| Heparin decision support for dose adjustment | 14 | Prototype being tested for possible Fall CareConnection implementation |
| Repeat echo alert | 14 | Cheryl to design alert for prototype development |
| Alerts for a PowerPlan in a planned state | 13 | Anupam to design alert for prototype development |
| Open chart alert for each patient with the same last name on each floor | 13 | Anupam to design prototype |
| Duplicate enoxaparin alert | 11 | Don to design alert for prototype development |
| History of blood transfusion reaction | 10 | Cheryl to design alert for prototype development |
| Stopping IV narcotics after three days | 8 | Need to identify someone to design the alert |
| NPO alert | 8 | Need to identify someone to design the alert |
| Abnormal vital signs prior to discharge | 5 | In testing |
| Documentation for details on specific medications for psychiatry | 5 | Order detail for specific medications needed |
| Inappropriate aspirin dosing with ticagrelor | 5 | Need to identify someone to design the alert |
| Duplicate testing alert prior to order signing | 4 | Need to identify someone to design the alert |
| Notify user that patient has expired | 2 | Need to identify someone to design the alert |
Miscellaneous
To-do items from previous meetings
[] Anupam to follow-up with PIT to determine how best to include oral and IV contrast orders in the abdominal/pelvic CT scan PowerPlan (March 2015)
Next meeting will be June 18, 2015 at 1500 hours
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