A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring

Am J Clin Pathol. 2003 Mar;119(3):432-8. doi: 10.1309/a96xu9yku298hb2r.


We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatient serum AED levels during two 3-month periods were included in the study. During the 3-month period after implementation of the automated intervention, 13% of all AED tests ordered were canceled following computerized reminders. For orders appearing redundant, the cancellation rate was 27%. For nonredundant orders, 4% were canceled when information on specific AED monitoring and pharmacokinetics was provided. The cancellation rate was sustained after 4 years. There has been a 19.5% decrease in total AED testing volume since implementation of this intervention, despite a 19.3% increase in overall chemistry test volume. Inappropriateness owing to repeated testing before pharmacologic steady state was reached decreased from 54% of all AED orders to 14.6%. A simple, automated, activity-based intervention targeting a specific test-ordering behavior effectively reduced inappropriate laboratory testing. The sustained benefit supports the idea that computerized interventions may durably affect physician behavior. Computerized delivery of such evidence-based boundary guidelines can help narrow the gap between evidence and practice.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Algorithms
  • Anticonvulsants / pharmacokinetics*
  • Anticonvulsants / therapeutic use
  • Benchmarking
  • Clinical Pharmacy Information Systems*
  • Drug Monitoring / methods*
  • Drug Prescriptions
  • Drug Therapy, Computer-Assisted*
  • Evidence-Based Medicine / methods
  • Health Planning Guidelines
  • Hospitals, Teaching
  • Humans
  • Pharmacy Service, Hospital / organization & administration
  • Reminder Systems*
  • Unnecessary Procedures


  • Anticonvulsants