Analysis of overridden alerts in a drug-drug interaction detection system

Mille, F.; Schwartz, Céline; Brion, F.; Fontan, Jean-Eudes; Bourdon, Olivier; Degoulet, Patrice; Jaulent, Marie-Christine

doi:10.1093/intqhc/mzn038

Cited by 35 publications

(30 citation statements)

References 19 publications

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“…current literature that recognises the importance of alert presentation and its effect on workflow. [7][8][9] These themes will be explored further to ensure that system design is in line with expectations.…”

Section: Discussionmentioning

confidence: 99%

Paediatric prescribing practice and opinions of paediatric prescribers on ePrescribing†

Burridge

Terry

Wilson

2014

International Journal of Pharmacy Practice

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Section: Discussionmentioning

confidence: 99%

Paediatric prescribing practice and opinions of paediatric prescribers on ePrescribing†

Burridge

Terry

Wilson

2014

International Journal of Pharmacy Practice

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“…We also decided to introduce drugs classified as relevant and potentially dangerous by the bibliography to avoid alert fatigue. In real practice there are many publications which show that the alerts are not always successful in fulfilling their purpose and do not reduce medication errors 24. The most common cause of this failure is that many clinicians ignore the warnings because they become excessive or difficult to find or understand 25.…”

Section: Discussionmentioning

confidence: 99%

Impact of electronic prescription alerts on medication errors related to vitamin K antagonists in hospitalised patients

et al. 2013

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Objectives To analyse the impact of the computerised prescription order entry (CPOE) alerts on the reduction of errors due to medication interactions in the prescribing process of vitamin K antagonists. Methods Prospective study over 3 months in a 1400-bed university tertiary care centre gifted with CPOE software, which includes medication interaction alerts. Adult patients receiving oral anticoagulant treatment with vitamin K antagonists with international normalised ratio ≥4 were included. The reason for their hyperanticoagulation was evaluated. We analysed the impact of incorporating interactive alerts in the prescription of vitamin K antagonists in terms of reduction of medication errors by comparing results with a previous period with no interaction alerts incorporated in the software. The main outcome measure was medication errors. Results Implementation of alerts reduced the number of medication errors caused by drug interactions by 71.4% (p=0.02). The number of errors diminished from 10.5 per month to 3 when interaction alerts were introduced. Conclusions Implementation of a CPOE interaction alert programme reduces interaction errors. Additionally, the use of this new technology allowed us to perform a thorough analysis of data and to identify and implement actions aimed at improving patient safety.

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“…In this study, the system used was not designed for paediatric use, and it had many drug duplicate alerts overridden due to limitations in complex or variable dosing patterns 33. A paediatric study on drug–drug interaction alerts found that 69% of these were overridden, and of these, 45% were informational or system errors, as the system lacked the ability to recognise real interactions and conflicted with guidelines that stated the drugs could be used together 32. A third study tested dosing suggestion alerts where the top 200 paediatric drugs had dosing rules attached for their most common indication 34.…”

Section: Handling Of Cdss Alertsmentioning

confidence: 99%

Support tools for paediatric inpatient prescribers: a review: Table 1

2013

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Prescribing support for paediatrics is diverse and includes both standard texts and electronic tools. Evidence concerning who should be supported and by what method is limited. This review aims to collate the current information available on prescribing support in paediatrics. Many tools designed to support prescribers are technology based. For example, electronic prescribing and smart phone applications. There is a focus on prescriber education both at undergraduate and postgraduate level. In the UK, the majority of inpatient prescribing is done by junior medical staff. It is important to ensure they are competent on qualification and supported in this role. A UK national prescribing assessment is being trialled to test for competence on graduation and there are also tools available to test paediatric prescribing after qualification. No information is available on the tools and resources UK prescribers currently use to support their decision making. One US study reported a decrease in the availability of paediatric prescribing information in a popular reference text. There is limited evidence to show that decision-support tools improve patient outcomes, however, there is growing confirmation that electronic prescribing reduces medication errors. There have been reports of new error types, such as selection errors, occurring with the use of electronic prescribing. Another concern with computerised decision-support systems is deciding what alerts should be presented to the prescriber and when/how often in order to avoid alert fatigue. There is little published concerning paediatric alerts perhaps as a consequence of commercial systems often not including paediatric specific support.

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Analysis of overridden alerts in a drug-drug interaction detection system

Cited by 35 publications

References 19 publications

Paediatric prescribing practice and opinions of paediatric prescribers on ePrescribing†

Paediatric prescribing practice and opinions of paediatric prescribers on ePrescribing†

Impact of electronic prescription alerts on medication errors related to vitamin K antagonists in hospitalised patients

Support tools for paediatric inpatient prescribers: a review: Table 1

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