Use of Clinical Decision Support to Increase Premedication Regimen Homogeneity.

Abstract

Patients with prior allergic reactions to iodinated contrast require premedication. This study aimed to increase the homogeneity of premedication orders in such patients. A point-of-care (POC) clinical decision support (CDS) alert accompanied by an order set was implemented in the electronic health record (EHR) to notify providers of a prior allergic reaction upon ordering an examination involving iodinated contrast. Premedication regimens were retrospectively compared 11 months pre- and 11 months post-alert implementation, with the different regimens being classified as follows: (1) "preferred" (per ACR recommendations), (2) "nonpreferred" (corticosteroid administered <24 hours before examination, but not per ACR recommendations), or (3) "no premedication." Over 22 months, 22,023 iodinated contrast examinations were performed, 200 (186 intravascular, 12 gastrointestinal/genitourinary, 1 intraarticular, 1 intrathecal) being in patients with a documented iodinated contrast allergy (106 pre-, 94 post-alert deployment). Prealert, 41 of 106 patients (38.7%) received a preferred regimen, 47 (44.3%) received nonpreferred regimens, and 18 (17.0%) received no premedication. Postalert, 58 of 94 patients (61.7%) received a preferred regimen, 21 (22.3%) nonpreferred regimens, and 15 (16.0%) no premedication. After alert initiation, the patients prescribed a preferred regimen significantly increased (Z-score = 3.25, P = .001), but there was no significant difference in the proportion of patients with no premedication (Z-score = -0.02, P = .85). In 2 of 200 patients (1.0%), an allergic reaction occurred, both after POC-CDS alert implementation with a preferred regimen administered. The homogeneity of premedication regimens significantly increased after the alert's launch. However, the proportion of patients with no premedication did not significantly change.