Factors associated with medication warning acceptance for hospitalized adults

Knight, Amy M.; Falade, Olufunmilayo; Maygers, Joyce; Sevransky, Jonathan

doi:10.1002/jhm.2258

Cited by 16 publications

(17 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…37 This is consistent with our findings that almost every type of provider is more likely to override a drug alert for an opioid. Additionally, opioid drug-allergy alerts are twice as likely to be overridden compared with nonopioid alerts, likely because opioid intolerances were charted as drug allergies.…”

Section: Discussionsupporting

confidence: 91%

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

Genco

Forster

Flaten

et al. 2016

Annals of Emergency Medicine

View full text Add to dashboard Cite

Study objective We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events. Methods This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support. Results Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden. Conclusion Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.

show abstract

Section: Discussionsupporting

confidence: 91%

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

Genco

Forster

Flaten

et al. 2016

Annals of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…After implementing the new system, it is critical for users or providers to monitor the impact of the system and if necessary, improve the alert contents [43,[45][46][47]. This study confirmed that system optimization would be required and can be achieved by monitoring the impact of alerts or information provision in medical institutions.…”

Section: Adherence To Alerts or Informationsupporting

confidence: 57%

“…However, we speculated that the doctors might have assumed that reconstitution solutions for IV preparation have a low impact on the clinical outcomes of the patients and, therefore, ignored the repeated alerts in the EMR [36,[40][41][42][43][44].…”

Section: Adherence To Alerts or Informationmentioning

confidence: 99%

Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

Shin

Lee

et al. 2016

International Journal of Medical Informatics

View full text Add to dashboard Cite

“…However, in clinical practice, automated alerts from CDSS are mostly oversensitive and clinically irrelevant . Such overalerting without clinical implications may lead to alert fatigue and ultimately to indiscriminate alert overriding or deactivation of the CDSS . For an effective prevention of paracetamol overdosing, alerts should therefore only be issued in clinically relevant situations, that is when they imply a risk of adverse events and require the prescriber to take action …”

Section: What Is Known and Objectivementioning

confidence: 99%

Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme

et al. 2016

View full text Add to dashboard Cite

WHAT IS KNOWN AND OBJECTIVES Paracetamol is a frequently used antipyretic and analgesic drug, but also a dose-dependent hepatotoxin. Unintentional paracetamol overdosing is a common medication error in hospitals. The present study aimed at (i) analysis of unintentional paracetamol overdosing in hospitalized patients; (ii) development, implementation and outcome analysis of an alert algorithm for the prevention of relevant paracetamol overdosing. METHODS All patients who received paracetamol in a Swiss tertiary care hospital during 2011 to 2014 were analysed to detect cases of paracetamol overdosing in a local pharmacoepidemiological database. In 2014, an automated algorithm screened the hospital's electronic prescribing system for patients at risk of overdosing, followed by expert validation. When imminent relevant overdosing was confirmed, alerts were issued to prescribers. Relevance was defined as prescriptions that permitted repeated daily paracetamol exposure of 5 g. RESULTS AND DISCUSSION From 2011 to 2013, relevant overdosing occurred in 11 patients (5-8 g/day for 3 to 5 days), which corresponds to 0·4 % of all patients exposed to any paracetamol overdosing (mean n = 988 per year). In 2014, alerts were issued by experts in 23 cases with subsequent changes to prescriptions in 21 (91·3 %) thereof. Although the occurrence of any paracetamol overdosing declined only marginally in 2014 (n = 914), no relevant overdosing occurred anymore. WHAT IS NEW AND CONCLUSION Unintentional paracetamol overdosing was frequent but only a small fraction thereof was deemed relevant. This proof of concept study analysed local hospital data and developed a preventive system combining sensitive automated detection with subsequent specific expert validation. The resulting alerts achieved high compliance and prevented relevant paracetamol overdosing. SUMMARYWhat is known and objectives: Paracetamol is a frequently used antipyretic and analgesic drug, but also a dose-dependent hepatotoxin. Unintentional paracetamol overdosing is a common medication error in hospitals. The present study aimed at 1)Analysis of unintentional paracetamol overdosing in hospitalized patients; 2)Development, implementation and outcome of an alert algorithm for the prevention of considerable paracetamol overdosing. Methods:All patients who received paracetamol in a Swiss tertiary care hospital during 2011 to 2014 were analysed to detect cases of paracetamol overdosing in a local pharmacoepidemiological database. In 2014 an algorithm screened the hospital's electronic prescribing system for patients at risk of considerable overdosing, followed by expert validation. When such overdosing was confirmed as imminent, alerts were issued to prescribers. Considerable overdosing was defined as prescriptions that permitted repeated daily paracetamol exposure of ≥ 5 g. Results and What is new and Conclusion:This proof of concept demonstrates that analyzing local hospital data allows the development of alert algorithms that successfully prevent relevant medi...

show abstract

Factors associated with medication warning acceptance for hospitalized adults

Cited by 16 publications

References 41 publications

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme

Contact Info

Product

Resources

About