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Using the electronic medical record to improve education in patients at risk for adrenal insufficiency.

Schweiger B, Zeitler P, Eppley S, Swietlik M, Barker J - Int J Pediatr Endocrinol (2010)

Bottom Line: Conclusion.This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids.Whether this translates into better outcomes for patients remains to be seen.

View Article: PubMed Central - PubMed

Affiliation: The Children's Hospital, University of Colorado Denver, East 16th Avenue, B265 Aurora, CO 13123, USA.

ABSTRACT
Background. Adrenal insufficiency is a life-threatening event. It is recommended that patients with known adrenal insufficiency and their families receive careful and repeated education on sick-day glucocorticoid management. We hypothesized that the electronic medical record (EMR) can be used to improve patient education through automated provider notification. Methods. We established an automated electronic alert in the EMR that triggered in the outpatient endocrine clinic. The alert asked if stress dose education was reviewed at the visit. The response to this alert was evaluated between July 15, 2009 and February 19, 2010. Results. 128 unique patients had visits both prior to and following the implementation of the EMR alert. The alert was acknowledged in 58 unique patient visits. After the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to implementation of the alert, 48/128 (38%) of the patient encounters showed written documentation of stress dose review. Conclusion. This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids. Whether this translates into better outcomes for patients remains to be seen.

No MeSH data available.


Related in: MedlinePlus

(a) Best practice alert for emergency department. An alert triggers that states the patient requires immediate Accucheck and to consider stress dosing of hydrocortisone IM/IV. It also suggests calling Endocrine for further recommendations. (b) When the age is selected, an order will open and choose the appropriate dose (25 mg, 50 mg, 100 mg).
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fig3: (a) Best practice alert for emergency department. An alert triggers that states the patient requires immediate Accucheck and to consider stress dosing of hydrocortisone IM/IV. It also suggests calling Endocrine for further recommendations. (b) When the age is selected, an order will open and choose the appropriate dose (25 mg, 50 mg, 100 mg).

Mentions: We have now established a similar alert within our hospital emergency department that will appear for any patient who presents with adrenal insufficiency and/or who is on steroids (oral or IV) (Figures 3(a) and 3(b)). The alert will trigger in triage and direct the nurse to obtain a finger stick blood glucose and alert the emergency physician immediately. The alert will also provide 3 weight-based stress doses for the physician. Evaluation of the success of this program in reducing time to treatment in the ED is underway. A similar initiative is being developed for the surgery department.


Using the electronic medical record to improve education in patients at risk for adrenal insufficiency.

Schweiger B, Zeitler P, Eppley S, Swietlik M, Barker J - Int J Pediatr Endocrinol (2010)

(a) Best practice alert for emergency department. An alert triggers that states the patient requires immediate Accucheck and to consider stress dosing of hydrocortisone IM/IV. It also suggests calling Endocrine for further recommendations. (b) When the age is selected, an order will open and choose the appropriate dose (25 mg, 50 mg, 100 mg).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2913793&req=5

fig3: (a) Best practice alert for emergency department. An alert triggers that states the patient requires immediate Accucheck and to consider stress dosing of hydrocortisone IM/IV. It also suggests calling Endocrine for further recommendations. (b) When the age is selected, an order will open and choose the appropriate dose (25 mg, 50 mg, 100 mg).
Mentions: We have now established a similar alert within our hospital emergency department that will appear for any patient who presents with adrenal insufficiency and/or who is on steroids (oral or IV) (Figures 3(a) and 3(b)). The alert will trigger in triage and direct the nurse to obtain a finger stick blood glucose and alert the emergency physician immediately. The alert will also provide 3 weight-based stress doses for the physician. Evaluation of the success of this program in reducing time to treatment in the ED is underway. A similar initiative is being developed for the surgery department.

Bottom Line: Conclusion.This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids.Whether this translates into better outcomes for patients remains to be seen.

View Article: PubMed Central - PubMed

Affiliation: The Children's Hospital, University of Colorado Denver, East 16th Avenue, B265 Aurora, CO 13123, USA.

ABSTRACT
Background. Adrenal insufficiency is a life-threatening event. It is recommended that patients with known adrenal insufficiency and their families receive careful and repeated education on sick-day glucocorticoid management. We hypothesized that the electronic medical record (EMR) can be used to improve patient education through automated provider notification. Methods. We established an automated electronic alert in the EMR that triggered in the outpatient endocrine clinic. The alert asked if stress dose education was reviewed at the visit. The response to this alert was evaluated between July 15, 2009 and February 19, 2010. Results. 128 unique patients had visits both prior to and following the implementation of the EMR alert. The alert was acknowledged in 58 unique patient visits. After the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to implementation of the alert, 48/128 (38%) of the patient encounters showed written documentation of stress dose review. Conclusion. This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids. Whether this translates into better outcomes for patients remains to be seen.

No MeSH data available.


Related in: MedlinePlus