Advancing the Use of Clinical Decision Support to Prevent Drug-Associated AKI

Abstract

Clinical decision support (CDS) has repeatedly been successful in improving the physicians' drug prescribing for patients with kidney disease. Alerts aimed at drug dosing may address prevention of drug accumulation, but might miss situations when a high-risk patient still receives a nephrotoxin. Alert advancement requires CDS that is focused on the appropriate use of potentially nephrotoxic medications. Unfortunately, the literature is replete with examples of inaccurate or ineffective alerts. However, analyzing these efforts will allow us to advance CDS to be more effective and to better understand how to include early detection of drug-associated acute kidney injury. Attempts have been made to address these limitations of CDS, but there are still opportunities for improvement.

Evaluation of medication-related clinical decision support alert overrides in the intensive care unit

“…Early detection of AKI would be of most benefit, although data supporting CDS remains controversial. [36] Finally, it may be useful to inform providers that overrides and their documented reason for override are being evaluated. [37] Our study had several limitations.…”

Acute kidney injury

“…Electronic clinical decision support systems can be integrated into primary care clinical information systems to aid with decision making in patients with either AKI or CKD. They provide alerts and can recommend prescribing schedules and doses based on patient characteristics to guide prescribing (Kane-Gill and Kellum, 2016).…”