Gregory S Day1, Safiya Ladak2, C Martin Del Campo2. 1. Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont. day.gregory@mayo.edu. 2. Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: Oral thiamine therapy is frequently prescribed to patients at risk for thiamine deficiency despite recommendations emphasizing the need for high doses of parenteral thiamine to reverse brain thiamine deficits. We evaluated the effect of changes to the computerized provider order entry system on the proportion of prescriptions for parenteral thiamine treatment (primary outcome) and dosages prescribed (secondary outcome) within our academic hospital network. METHODS: We obtained data from the pharmacy information system recording thiamine prescribed to inpatients at University Health Network hospitals (Toronto, Ontario) before (Jan. 1, 2010, to Dec. 31, 2011) and after (Nov. 21, 2013, to Apr. 30, 2017) changes to the computerized provider order entry system promoting the use of higher dosages (≥ 200 mg) of parenterally administered thiamine. Patients receiving thiamine as part of total parenteral nutrition were excluded from analyses, as thiamine prescribing was automated and unlikely to be affected by the intervention. RESULTS: A total of 6105 thiamine prescriptions were written for 2907 patients before the intervention and 12 787 thiamine prescriptions for 8032 patients after the intervention. The proportion of prescriptions for parenteral treatment increased from 55.5% (3386/6105) to 92.5% (11 829/12 787) after the intervention (p < 0.001). Increases in prescribing of parenteral thiamine treatment were sustained or enhanced across the 3.4-year observation period and were realized across all hospital services. Prescriptions for higher dosages of thiamine increased from 1.1% (65/6105) to 61.4% (7845/12 787) after the intervention (p < 0.001). INTERPRETATION: Changes to the computerized provider order entry system were associated with sustained increases in the proportion of prescriptions for high-dose parenteral thiamine therapy. Similar approaches may be leveraged to align prescriber behaviour with well-accepted practice parameters in other areas of medicine. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: Oral thiamine therapy is frequently prescribed to patients at risk for thiaminedeficiency despite recommendations emphasizing the need for high doses of parenteral thiamine to reverse brain thiamine deficits. We evaluated the effect of changes to the computerized provider order entry system on the proportion of prescriptions for parenteral thiamine treatment (primary outcome) and dosages prescribed (secondary outcome) within our academic hospital network. METHODS: We obtained data from the pharmacy information system recording thiamine prescribed to inpatients at University Health Network hospitals (Toronto, Ontario) before (Jan. 1, 2010, to Dec. 31, 2011) and after (Nov. 21, 2013, to Apr. 30, 2017) changes to the computerized provider order entry system promoting the use of higher dosages (≥ 200 mg) of parenterally administered thiamine. Patients receiving thiamine as part of total parenteral nutrition were excluded from analyses, as thiamine prescribing was automated and unlikely to be affected by the intervention. RESULTS: A total of 6105 thiamine prescriptions were written for 2907 patients before the intervention and 12 787 thiamine prescriptions for 8032 patients after the intervention. The proportion of prescriptions for parenteral treatment increased from 55.5% (3386/6105) to 92.5% (11 829/12 787) after the intervention (p < 0.001). Increases in prescribing of parenteral thiamine treatment were sustained or enhanced across the 3.4-year observation period and were realized across all hospital services. Prescriptions for higher dosages of thiamine increased from 1.1% (65/6105) to 61.4% (7845/12 787) after the intervention (p < 0.001). INTERPRETATION: Changes to the computerized provider order entry system were associated with sustained increases in the proportion of prescriptions for high-dose parenteral thiamine therapy. Similar approaches may be leveraged to align prescriber behaviour with well-accepted practice parameters in other areas of medicine. Copyright 2020, Joule Inc. or its licensors.
Authors: Lisa L Kirkland; Deanne T Kashiwagi; Susan Brantley; Danielle Scheurer; Prathibha Varkey Journal: J Hosp Med Date: 2012-10-12 Impact factor: 2.960
Authors: Flora I Matheson; Katherine L W Smith; Rahim Moineddin; James R Dunn; Richard H Glazier Journal: J Epidemiol Community Health Date: 2013-09-06 Impact factor: 3.710
Authors: Rahul D Pawar; Lakshman Balaji; Anne V Grossestreuer; Garrett Thompson; Mathias J Holmberg; Mahmoud S Issa; Parth V Patel; Ryan Kronen; Katherine M Berg; Ari Moskowitz; Michael W Donnino Journal: Ann Intern Med Date: 2021-12-07 Impact factor: 51.598