Clinical decision support systems have been shown to improve practitioner performance. Most systems designed to prevent medication errors generate lists with patients who fulfill the criteria of the algorithm. These lists are reviewed by a pharmacist and physicians are contacted by telephone. Presenting pop-up alerts as part of the workflow with a clear recommendation is a feature critical to success. Therefore we implemented three algorithms in a clinical decision support system alerting during the medication ordering process. We analyzed whether the recommendations in these alerts were followed. We evaluated 1. whether folic or folinic acid was co-prescribed more frequently within 48 h after ordering methotrexate, 2. whether vitamin D or analogues were co-prescribed more frequently within 48 h after ordering bisphophonates and 3. whether sodium lowering drugs were stopped more frequently within one hour in patients with hyponatremia. We analyzed the difference in the 48 days before implementation and the 43 days after implementation, using Pearson's Chi test. Co-prescription of folic or folinic acid increased from 54 to 91% (p = 0.014), co-prescription of vitamin D or analogues increased from 11 to 40% (p = 0.001) and the number of stopped orders for sodium lowering drugs increased from 3 to 14% (p = 0.002). This clinical decision support system that alerts physicians for preventable medication errors during the medication ordering process is an effective approach to improve prescribing behavior.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.