*Purpose: Use of high-risk medications (HRMs) at the time of liver transplant may lead to delays in surgery or peri-operative complications (bleeding, drug-drug interactions (DDI), impaired healing, lapse in therapy). Additionally, patient-specific serologies may require time-sensitive pharmacological intervention to prevent recurrent disease. HRMs identified include direct-oral anticoagulants (DOAC), dual antiplatelet therapy (DAPT), mammalian target of rapamycin inhibitors (mTORi), buprenorphine-containing therapies, and methadone. The goal of this QI project is to describe the initial development and implementation of electronic medical record (EMR) generated reports that identify HRMs, allergies and serologies in waitlisted liver transplant candidates (LTCs) in real-time.

*Methods: This prospective, quality improvement project was implemented in August 2020 at a 1000-bed academic medical center. Reports identified HRMs, allergies and serologies in real time for LTCs via EMR) data-extraction reports with supplemental chart review. Reports were compiled into a spreadsheet with interprofessional notification to ensure appropriate intervention prior to transplantation. Time to intervention and action taken are reported using descriptive statistics.

*Results: A total of 62 LTCs were identified to be high risk secondary to HRM, allergy or positive HBsAg serology between September to December 2020. Interventions were recorded as seen in Table 1. Time to intervention deemed as addition of alert in EMR or medication issue resolved. The most common medication-related interventions included medication discontinued (11), note added to patient chart (9), changing to preferred therapy (3), and updating medication list with discontinuation (1).

*Conclusions: Solid organ transplant candidates have multiple providers and variable wait times prior to transplantation, where real-time EMR reviews of LTCs may help facilitate time-appropriate intervention prior to transplantation. Future efforts include expanding EMR review to all solid organ transplant waitlist candidates, with information extraction to be adjusted for relevance per organ.

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