Biomedical subjects

Laura A Noirot

Publications and source records attributed to Laura A Noirot.

9 recordsLinked to original sources

PubMed2005

Strategies for reducing nuisance alerts in a dose checking application.

Commercial rule bases can be implemented to identify medication orders that fall outside recommended dosage ranges, but they are likely to produce an excessive number of nuisance and clinically insignificant alerts. Strategies for customizing commercial dosing rules can be implemented to minimize this problem. This paper describes specific strategies implemented in a dose checking application necessary for achieving a clinically acceptable alert rate.

Clinical Pharmacy Information Systems↗

PubMed2005

Automatic detection of spironolactone - related adverse drug events.

Due to increasing reports of spironolactone associated life-threatening hyperkalemia, we implemented a rule in our automated event detection system to monitor serum potassium results in patients receiving spironolactone. In 2004, 419 (10.49%) of 3995 admissions at 3 BJC HealthCare hospitals were identified as having hyperkalemia while on spironolactone. For a 9-month period in one facility, 33 of 52 automatically detected potential ADEs had been validated by pharmacists through manual chart review to have spironolactone as a contributing factor (PPV=63.5%).

Adverse Drug Reaction Reporting Systems↗

PubMed2005

Using outpatient prescription claims to evaluate medication adherence in an acute myocardial infarction population.

We have previously shown that using computerized alerts and academic detailing results in significant improvement in physician adherence to secondary prevention guidelines for acute myocardial infarction. However, information about patient medication adherence after hospital discharge was not previously available. Using electronic outpatient prescription claims data, medication adherence for a coronary artery disease population is described.

Ambulatory Care↗

PubMed2005

Physicians' knowledge and attitudes about coronary heart disease prevention guidelines and technology assisted interventions.

BJC Healthcare is conducting a randomized controlled study to evaluate the impact of a technology-assisted pharmacist intervention on physicians' adherence to national coronary heart disease (CHD) prevention guidelines. We surveyed physicians to assess their knowledge of the guidelines and attitudes toward pharmacist-mediated interventions.

Attitude of Health Personnel↗

PubMed2005

Customizing a commercial rule base for detecting drug-drug interactions.

We developed and implemented an adverse drug event system (PharmADE) that detects potentially dangerous drug combinations using a commercial rule base. While commercial rule bases can be useful for rapid deployment of a safety net to screen for drug-drug interactions, they sometimes do not provide the desired rule sensitivity. We implemented methods for enhancing commercial drug-drug interaction rules while preserving the original rule base architecture for easy and low cost maintenance.

Adverse Drug Reaction Reporting Systems↗

PubMed2003

Monitoring pharmacy expert system performance using statistical process control methodology.

Automated expert systems provide a reliable and effective way to improve patient safety in a hospital environment. Their ability to analyze large amounts of data without fatigue is a decided advantage over clinicians who perform the same tasks. As dependence on expert systems increase and the systems become more complex, it is important to closely monitor their performance. Failure to generate alerts can jeopardize the health and safety of patients, while generating excessive false positive alerts can lead to valid alerts being dismissed as noise. In this study, statistical process control charts were used to monitor an expert system, and the strengths and weaknesses of this technology are presented.

Clinical Pharmacy Information Systems↗

PubMed2003

Validation of automated event triggers using laboratory values related to two problem-prone drugs.

We used computerized alerts to identify patients with laboratory values that could be related to medication errors associated with digoxin and warfarin. Over a six-week period at two inpatient facilities, we generated 62 laboratory-based alerts for warfarin, and 66 for digoxin. The positive predictive value for these alerts representing a preventable event was 71% and 57% for warfarin and digoxin, respectively.

Anticoagulants↗

PubMed2003

Implementing a commercial rule base as a medication order safety net.

A commercial rule base was used to identify drug orders exceeding standard dosage limits at a university hospital. Initially, there were substantial numbers of clinically insignificant alerts. A method for altering the commercial rule base will be implemented to increase rule specificity for problematic drugs. With minor modifications, commercial rule bases can be used to rapidly create a safety net that screens drug orders for excessive dosages, while preserving the rule architecture for more finely tuned clinical decision support.

Drug Therapy, Computer-Assisted↗

PubMed2002

Implementation of an automated guideline monitor for secondary prevention of acute myocardial infarction.

Clinical practice guidelines can be used to help improve health care quality, but they are often not optimally implemented. Practice enabling and reinforcing techniques, such as clinical reminders and academic detailing are effective methods for translating guidelines into practice. Following a study showing that we could improve adherence to secondary prevention guidelines for acute myocardial infarction (AMI) using computerized alerts and academic detailing, we implemented an automated monitor to accomplish the same goal in a less labor-intensive manner. This paper describes the implementation of this production application.

Drug Therapy, Computer-Assisted↗