Medication stewardship using computerized clinical decision support: A case study on intravenous immunoglobulins

BACKGROUND: Healthcare delivery organizations face increasing pressure to manage the use of medications in terms of safety, waste reduction, and cost containment. OBJECTIVE: To describe a computerized provider order entry (CPOE) system intervention to optimize use of a commonly ordered, high‐cost therapeutic: intravenous immune globulin (IVIG). DESIGN: Description of IVIG order configuration, medication use patterns, and subsequent order set configuration development in a CPOE system. MEASUREMENTS: IVIG orders were extracted from the CPOE system before and after the implementation of a specialty orderset to determine the indications for use, dosing, and duration of therapy. Orders were compared to a theoretical dosing schedule created from published evidence and data from a prior medication use evaluation. RESULTS: During 36 months before the implementation of the IVIG order set, 1965 IVIG orders were reviewed. The prescribed IVIG dose varied considerably from the expected dose (mean = −1.8, range = −4.9‐1.5). In the 27 months after order set implementation, 848 IVIG orders were reviewed. The prescribed IVIG dose was closer to the expected dose (mean = −1.2, range = −3.9‐2.6, P < .0001). CONCLUSIONS: Order configuration processes are cumbersome and time‐consuming, but can be streamlined to enhance a medication’s usage in the healthcare system. A better understanding of institution‐specific ordering patterns may facilitate more efficient and effective order configuration and optimize drug use.