Physicians′ override of computerized alerts for contraindicated medications in patients hospitalized with chronic kidney disease

Abstract

Objectives: To determine the effectiveness of a clinical decision support system (CDSS) as indicated by a lower proportion of receiving contraindicated medications by patients with severe chronic kidney disease (CKD) compared with patients with less severe CKD. Materials and Methods: This was a retrospective analysis of inpatients with CKD (ICD9-CM 585.xx) admitted to a major tertiary hospital in Saudi Arabia and receiving one of the medications that were documented in the knowledge base of the hospital CDSS to be renally cleared and/or nephrotoxic. Using the Chi square test, the proportion of receiving contraindicated medication was compared between patients with severe CKD and patients with mild/moderate CKD. Multivariate logistic regression was then used to examine the adjusted risk of receiving contraindicated medications among patients with severe CKD despite the presence of guided medication by CDSS. Results: The final analysis was conducted on 346 patients who received prescriptions that were renally cleared and/or nephrotoxic. Of these patients, 17% (n = 58) had severe CKD and 83% (n = 288) had mild/moderate CKD. Among patients with severe CKD, 51.7% (n = 30) received contraindicated medications compared with patients with mild/moderate CKD, 4.9% (n = 14), P < 0.01. Multivariate logistic regression showed that the likelihood of receiving contraindicated medications was several folds higher among patients with severe CKD compared with patients with mild/moderate CKD (P < 0.001). Conclusion: Patients with severe CKD continued to receive contraindicated medications despite the availability of medication guidance by the CDSS to prescribing physicians. Improved compliance by physicians to CDSS alerts and better understanding of reasons for non-compliance is still needed, particularly for patients with severe CKD.

Keywords

• Computerized decision support system (CDSS)
• contraindicated medications
• override
• Saudi Arabia
• severe renal insufficiency