Protecting patients at Vail Health with Oracle’s Clinical Decision Support
Learn how one client uses Oracle Health technology to help promote patient safety.
“We want to prevent serious medication events from reaching our patients by optimizing medication ordering practices within our EHR”
In the United States, approximately 200,000 lives are lost annually as the result of preventable medication errors. Organizational factors, including a hospital or facility’s technological infrastructure, can play a key role in mitigating risks to patient safety.
In its mission to improve overall patient safety, Vail Health, a CMS 5-star accredited community healthcare system, engaged Oracle Health’s Continuous Improvement Delivery team. The team introduced enhanced electronic health record (EHR) functionality designed to support accurate medication ordering and related outcomes. These features encompassed medication Clinical Decision Support (mCDS), Dose-Range Checking (DRC), alert optimization, and advanced filters including route of administration, drug-age and drug-diagnosis.
By embedding mCDS and DRC, the team helped to increase the likelihood that clinicians were alerted to dosing guidelines, repeat prescriptions, or drugs that were not appropriate to be combined. These are among the most common types of adverse medication events and can cause a range of patient harm, including negative drug reactions, or even overdose.
“Dose Range Checking works like guardrails. For example, if you’re driving on a highway, you don't want to go too far left or right. With medications, you could underdose or overdose a patient. Either could be harmful,” says Washburn. “With these guardrails in place, clinicians are alerted when something isn’t right.”
Since implementation, as many as 4,200 medications have been covered for Dose Range Alerts within Vail Health’s EHR.1
Additionally, with support from mCDS, Vail Health saw an approximate 72% decrease in its overall alert rate,2 while simultaneously increasing its alert acceptance rate by 123%.3 Optimizing alert response helps to improve the chances that critical notifications are met with appropriate sensitivity and support quality care. Reducing alert fatigue can also impact workflows, alleviating pressure points across the ordering continuum.
“Safety systems were not enabled for the clinician prior to this optimization project. Most of the responsibility fell to pharmacists. Now, we have increased the number of medication alerts for physicians and decreased alerts for pharmacists,” says Washburn. “We can be hopeful medication errors are caught before the final safety check, when a nurse reaches the point of administration.”
To further support prescribing practices, additional Clinical Decision Support (CDS) was implemented to increase coverage of drug-related rules. This included filtering medication orders by route of administration, adding an extra layer of protection to indicate how medications should be given. After implementing additional CDS in June of 2022, coverage of medication orders with route of administration filters reached 97%.4
Drug-age and drug-diagnosis alerts were also introduced, notifying physicians when certain medications should not be ordered based on the patient's age or active diagnoses.
“Research supports ensuring medications and dosages are appropriate for those aged over 65. We now have the ability to warn physicians if a medication is on the Beers Criteria evidence-based recommendation list. Similarly, drug-diagnosis alerts are useful to identify contraindicated medications based on a patient’s documented diagnosis,” says Washburn.
In 2022, Vail Health achieved an A grade on Leapfrog’s annual Hospital Safety Survey, a nationally recognized quality measure created to promote transparent public reporting. Looking forward, the organization is optimistic.
“We continue to review data for improvement opportunities and will take our second Leapfrog CPOE Adult Inpatient test this year. Hopefully, we will do just as well,” says Washburn.
1 Based on data generated from Vail Health and Cerner Millennium as of March 6, 2023.
2 Data from pre-go live, June 1, 2021, to September 20, 2021, reflected an 88% alert rate; comparing this data against data pulled post go-live, June 1, 2022, to September 20, 2022, the overall alert rate was reduced to 25%. Using the formula for percentage change, total percentage decrease was 71.5%.
3 Data from pre-go live, June 1, 2021, to September 20, 2021, reflected an 3.5% alert acceptance rate. Comparing data from post go-live, June 1, 2022, to September 20, 2022, accepted alert rate increased to 8%. Using the formula for percentage change, a 128.5% increase in accepted alert rates was reflected as of March 6, 2023. Alert acceptance rate is determined by whether or not a physician modifies or cancels a medication order, rather than overriding the alert.
4 Based on data generated from Vail Health and Cerner Millennium as of March 6, 2023. Coverage indicates the number of orders, not the number of medications, that had route of administration filters activated for the 90 days prior to March 6, 2023.