Novel alert system improves prescriptions for kids on ketogenic diet

A clinical decision support (CDS) alert system that warns prescribers of carbohydrate-containing medication helps prevent the inappropriate administration of such treatments to children on ketogenic diet, a recent study has found.

Prior to the implementation of the current intervention, the charts of patients on ketogenic diet already showed an alert whenever opened, containing important information and considerations. This alert, however, was absent during order-entry.

The researchers thus compiled a list of medications with significant carbohydrate content and developed an alert that would fire whenever a provider tried to order one of these medications.

Over 17 months of assessment, 82 unique patients (median age, 6.4 years; 49 percent female) on ketogenic diet were admitted and followed for a total of 1,219 patient-days, 414 of which were pre-intervention and 805 were after the prescription CDS was implemented.

In the pre-intervention period, there was an average of 0.69 orders of carbohydrate-containing medications per patient-day. The novel alert system reduced such mis-prescriptions by 49 percent, dropping to 0.35 orders per patient-day (rate difference, 0.34, 95 percent confidence interval [CI], 0.25–0.43).

In absolute terms, 283 medication errors were made in the post-intervention period, down from the 539 expected errors had the novel alert system not been implemented. This indicates that the CDS alert system was able to avert 256 wrong prescriptions.

“Future research is needed to better understand the impact of reducing carbohydrate-containing medication orders on clinical outcomes such as maintenance of ketosis and seizure frequency,” the researchers said.