Effects of clinical decision support on initial dosing and monitoring of @entity2890 and XXXX .

@entity1 @entity4028 @entity2890 @entity4509
PURPOSE: The impact of clinical decision support (CDS) on initial doses and intervals and pharmacokinetic outcomes of @entity4509 and @entity2890 therapy was evaluated. METHODS: A complex CDS advisor to provide guidance on initial dosing and monitoring of @entity4028 orders, using both traditional-dosing and extended-interval-dosing strategies, was integrated into a computerized prescriber-order-entry (CPOE) system and compared with a control group whose @entity4028 orders were closely monitored by pharmacists. The primary outcome measured was an initial dose within 10% of a dose calculated to be adherent to published dose guidelines. Secondary outcomes included a guideline-adherent interval, trough and peak concentrations in goal range, and rate of nephrotoxicity. RESULTS: Of 216 @entity1 studied, 97 were prescribed @entity4509 and 119 were prescribed @entity2890 . The number of orders with initial doses consistent with reference standards increased from 40% in the preadvisor group to 80% in the postadvisor group (p < 0.001). Selection of the correct initial interval based on renal function increased from 63% to 87% (p < 0.001). The changes in the initial dosing and interval resulted in an increase of trough concentrations at goal (59% in the preadvisor group versus 89% in the postadvisor group, p = 0.0004). There was no significant difference in peak concentrations in the goal range or rate of nephrotoxicity. CONCLUSION: An advisor for @entity4028 dosing and monitoring integrated into a CPOE system significantly improved selection of initial doses and intervals and resulted in an improvement in the rate of trough serum drug concentrations at goal compared with standard provider dosing.
