The safety and well-being of patients are paramount in healthcare. A significant risk to patient safety arises from the concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and angiotensin system inhibitors, a combination known as the “triple whammy” (TW).

This combination has been identified as a significant risk factor for acute kidney injury (AKI), a severe complication that can lead to increased morbidity and mortality.

Recognizing the need to mitigate this risk, researchers have developed an innovative electronic algorithm to detect TW prescriptions among patients, particularly those with additional risk factors such as old age and impaired kidney function. This blog post explores this groundbreaking algorithm’s development, evaluation, and impact on patient safety.

The Development of the TW Detection Algorithm

The TW detection algorithm represents a leap forward in clinical pharmacology and patient care. Developed to run within hospital electronic health record systems, this algorithm automatically identifies patients prescribed the TW combination.

It prioritizes alerts based on additional risk factors for AKI, such as patient age and baseline kidney function. Once a potential risk is detected, the algorithm alerts a clinical pharmacist, who evaluates the situation and, if necessary, forwards the alert to the prescribing physician for review.

Evaluating the Algorithm’s Performance

The effectiveness of the TW detection algorithm was rigorously tested in a retrospective observational study at the Cantonal Hospital of Aarau in Switzerland throughout 2021. The study encompassed all adult patients admitted during the year, focusing on those who received a TW prescription, triggered a TW alert, or developed AKI during TW therapy.

The primary endpoints for evaluating the algorithm’s performance were its sensitivity and specificity in detecting patients at risk of AKI. Additionally, the study assessed the acceptance rate of the algorithm’s alerts among clinical pharmacists and physicians, serving as a secondary endpoint.

Results: A High Degree of Accuracy and Acceptance

Results - A High Degree of Accuracy and Acceptance - Safe Therapeutics

The study’s findings were highly encouraging. Out of 21,332 hospitalized patients, 290 received a TW prescription, and 12 of these patients experienced AKI.

The algorithm successfully detected 216 patients, including 11 of the 12 who developed AKI, demonstrating a sensitivity of 88.3% and a specificity of 99.7%. Notably, the acceptance rate of the algorithm’s alerts was high among physicians (77.7%), although some clinical pharmacists showed reluctance in forwarding the alerts to prescribers.

Conclusion: A Promising Tool for Enhancing Drug Safety

The TW detection algorithm is a highly sensitive and specific tool for identifying patients at risk of AKI due to TW therapy. Its successful implementation and the positive response from the medical community highlight its potential to enhance patient safety significantly.

By providing timely alerts and facilitating prompt review and adjustment of potentially harmful prescriptions, the algorithm offers a proactive approach to preventing AKI in vulnerable patients.

The high acceptance rate among physicians underscores the value of integrating advanced technology and clinical expertise to improve healthcare outcomes.

However, the observed reluctance among some clinical pharmacists to forward alerts indicates the need for further education and support to realize the algorithm’s full potential.

Integrating such innovative tools into clinical practice will be crucial in advancing patient safety and care quality as healthcare continues to evolve. The TW detection algorithm exemplifies how technology can be harnessed to protect patients from preventable harm, marking a significant step forward in improving medication safety.