Using an electronic clinical decision support system to reduce the risk of epidural hematoma

Am J Ther. 2014 Sep-Oct;21(5):327-30. doi: 10.1097/MJT.0b013e31825a3631.

Abstract

Epidural hematoma is a major complication that can occur when neuraxial anesthesia is used concurrently with newer anticoagulation and antiplatelet medications. In complex hospital environments, the opportunity of performing a neuraxial procedure in an anticoagulated patient or starting potent anticoagulants on a patient with existing epidural catheter still exists. We describe a technique to use an electronic clinical decision support ordering system that helps reduce this risk of epidural hematoma. Through a series of automated warnings that bring to light existing anticoagulant or antiplatelet medications at the time of doing the procedure or a secondary warning system to those practitioners initiating anticoagulant medications on a patient with an existing epidural, we hope to reduce the number of medication errors. Before initiating the alert system, we had 26 events noted in the medical chart over a 3-month period. We noted only 11 events after the initiation of the new alert systems and clinical decision support in a similar 3-month period. Using electronic clinical decision support systems can help reduce medication errors related to neuraxial anesthesia and anticoagulation medications in a large hospital system.

MeSH terms

  • Anesthesia, Epidural / adverse effects*
  • Anticoagulants / therapeutic use
  • Decision Support Systems, Clinical*
  • Hematoma, Epidural, Cranial / prevention & control*
  • Humans
  • Medication Errors / prevention & control
  • Risk

Substances

  • Anticoagulants