Use of Clinical Decision Support to Increase Premedication Regimen Homogeneity

Area of Science:

• Radiology
• Clinical Informatics
• Allergy and Immunology

Background:

• Patients with a history of allergic reactions to iodinated contrast media require premedication before contrast-enhanced examinations.
• Variability in premedication orders can impact patient safety and treatment efficacy.

Purpose of the Study:

• To enhance the uniformity of premedication orders for patients with documented allergies to iodinated contrast agents.
• To evaluate the impact of a point-of-care clinical decision support alert on premedication practices.

Main Methods:

• A point-of-care (POC) clinical decision support (CDS) alert integrated into the electronic health record (EHR) was implemented.
• The alert notified providers about prior iodinated contrast allergies when ordering relevant examinations.
• Premedication regimens were retrospectively analyzed pre- and post-alert implementation, categorized as preferred, nonpreferred, or no premedication.

Main Results:

• The study analyzed 200 patients with documented iodinated contrast allergies undergoing contrast-enhanced examinations.
• Post-alert implementation, the proportion of patients receiving preferred premedication significantly increased from 38.7% to 61.7% (P = .001).
• There was no significant change in the proportion of patients receiving no premedication (17.0% pre-alert vs. 16.0% post-alert).
• Allergic reactions occurred in 1.0% of patients, with both instances happening post-alert with preferred regimens.

Conclusions:

• The implementation of a POC-CDS alert significantly improved the homogeneity of premedication regimens for patients with prior iodinated contrast allergies.
• While preferred premedication increased, the alert did not significantly affect the rate of patients receiving no premedication.
• Further investigation may be warranted regarding the occurrence of reactions despite preferred premedication.