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临床知识模块:Screen for hypokalemia with digoxin therapy

(2007-05-25 10:55:27)
分类： 医院管理与医院信息化
 
 maintenance
 title  Screen for hypokalemia with digoxin therapy (triggered by potassium storage);;
 filename  astm_hypokalemia_and_digoxin;;
 version  
 institution  ASTM E31.15; Columbia-Presbyterian Medical Center;;
 author  Robert Jenders, M.D., M.S.
 specialist  
 date  
 validation  testing

library

 purpose  Warn the health care provider of hypokalemia in the setting of     digoxin therapy.;;
 explanation

 Whenever a serum or whole blood potassium value is stored, it is    checked for hypokalemia (less than 3.3).  If hypokalemia is present,     then if the patient has a non-zero serum digoxin level within the 3     months or an active order for digoxin administration, then an alert     is generated  (using the later of the level or the order).  It warns    that hypokalemia may potentiate digoxin arrhythmias.  Repeat alerts     are not generated if there has not been a new digoxin level or order     since the last alert.;;
 keywords  hypokalemia; digoxin; arrhythmia;;
 citations  

 knowledge

 type:  data-driven;;
 data:     /* evoke on storage of a serum or whole blood potassium*/
     storage_of_potassium := EVENT {storage of potassium};
     /* read the potassium that evoked the MLM */
     potassium := READ LAST {potassium level};
     /* get the last active digoxin or digitoxin order */
     digoxin_order := read last {digoxin order};
 evoke    /* evoke on storage of a serum or whole blood potassium */
     storage_of_potassium;;
 logic:  /* exit if the potassium value is invalid */
     if potassium is not number then
          conclude false;
     endif;
/* exit if there is no hypokalemia */
     if potassium >= 3.3 then
          conclude false;
     endif;

/* exit if indication of digoxin use cannot be found */
    if (digoxin_order is null) then
          conclude false;
     endif;

     /* send an alert */
     conclude true;
 action:  write "The patient's potassium level (" ||potassium|| " mEq/l on "
 ||time of potassium|| ") is low.  If the patient is currently taking digoxin, then the hypokalemia may potentiate the   development of digoxin-related arrhythmias.";
 urgency:  50
 

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