Selection of drug-laboratory result pairs for an inpatient asynchronous alert program: results of a Delphi survey

Abstract

Purpose: Combinations of drugs and laboratory values ("drug-laboratory pairs") that represent practical high-priority targets for potential use in a daily asynchronous inpatient clinical decision-support (CDS) alert report were identified.

Methods: A list of 654 drug-laboratory pairs compiled through a literature review was evaluated by a multidisciplinary expert panel in a modified Delphi procedure. After initial evaluation to narrow the list to 89 drug-laboratory pairs, panelists used Likert scales to rate the remaining pairs on six dimensions (frequency of alert, likelihood of harm, severity of harm, preventability, ameliorability, and global impression of usefulness) in Delphi survey rounds until consensus emerged. Final selection of pairs for potential use as CDS tools was based on global-impression-of-usefulness scores. Correlations between impression of usefulness and other evaluative dimensions were determined.

Results: The Delphi process yielded a final list of 24 high-priority drug-laboratory pairs. The highest-ranked pairs were heparin- low platelet count, potassium supplement- high serum potassium, angiotensin-converting-enzyme inhibitor-high serum potassium, and heparin-positive heparin platelet factor 4 antibody test. Medications on the final list included nine anticoagulants, six cardiologic agents, four antimicrobials, and two electrolytes. Most of the selected drug-laboratory pairs related to renal function, serum potassium levels, hematologic results, or pregnancy. Panelists' impression of usefulness was significantly correlated with severity-of-harm ratings (p < 0.0001).

Conclusion: Expert review of drug- laboratory value pairs for potential inclusion in an asynchronous monitoring program yielded 24 high-priority and practical pairs for monitoring. About 25% of the pairs had not been the focus of previous laboratory-pharmacy CDS at the study panelists' home institutions.