Improving medication-related clinical decision support

Tolley, Clare L.; Slight, Sarah P; Husband, Andy; Watson, Neil; Bates, David W.

doi:10.2146/ajhp160830

Cited by 75 publications

(79 citation statements)

References 65 publications

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“…They suggested that sensitivity and specificity of alerts should always be considered, with an emphasis on high specificity to decrease alert fatigue. They also proposed tiering of alerts to improve acceptance and consideration of human factors in CDS design [20] The analytic reviews analyzed the features of previously implemented CDS tools. Several reviews examined alert use, generally finding acceptance rates to be low [21] and override rates to be high [22][23][24].…”

Section: Resultsmentioning

confidence: 99%

“…Using the techniques of improving relevance, soliciting feedback, customization, measurement of outcomes and metrics, and iteration, the effects of CDS on burnout can be ameliorated. [20,24,97] -Role tailoring of alerts [21,82] -Tiering of alerts [20,80] -Iterative design [25] Harmful -Interruptive or hard stop alerts [21,25,80] -Lack of "right information" [18] -Lack of relevance [80,97,108] -Lack of integration [78]…”

Section: Resultsmentioning

confidence: 99%

“…Separate from role-tailoring, CDS that "nudges" [26] could be used to combat concerns about loss of autonomy [67]. Relevance could also be improved by tiering of alerts [20,22]. For example, when one hospital disabled the least severe drug interaction alerts, alert burden fell by over 50% [69].…”

Section: Fix It -Improving Cdsmentioning

confidence: 99%

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Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković

Chen

2020

Yearb Med Inform

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Objectives: This survey aimed to review aspects of clinical decision support (CDS) that contribute to burnout and identify key themes for improving the acceptability of CDS to clinicians, with the goal of decreasing said burnout. Methods: We performed a survey of relevant articles from 2018-2019 addressing CDS and aspects of clinician burnout from PubMed and Web of Science™. Themes were manually extracted from publications that met inclusion criteria. Results: Eighty-nine articles met inclusion criteria, including 12 review articles. Review articles were either prescriptive, describing how CDS should work, or analytic, describing how current CDS tools are deployed. The non-review articles largely demonstrated poor relevance and acceptability of current tools, and few studies showed benefits in terms of efficiency or patient outcomes from implemented CDS. Encouragingly, multiple studies highlighted steps that succeeded in improving both acceptability and relevance of CDS. Conclusions: CDS can contribute to clinician frustration and burnout. Using the techniques of improving relevance, soliciting feedback, customization, measurement of outcomes and metrics, and iteration, the effects of CDS on burnout can be ameliorated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković

Chen

2020

Yearb Med Inform

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“…This improvement should include more patient-specific information in order to reduce alert fatigue. 21,22 Second, alerts run in real time, and the system continuously performs searches for new orders and laboratory test values. This feature differs from many commercially available CDSS, in which real-time analysis is not available.…”

Section: Discussionmentioning

confidence: 99%

Development and Evaluation of a Clinical Decision Support System to Improve Medication Safety

et al. 2019

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Background Clinical decision support systems (CDSSs) are a good strategy for preventing medication errors and reducing the incidence and severity of adverse drug events (ADEs). However, these systems are not very effective and are subject to multiple limitations that prevent their implementation in clinical practice. Objectives The objective of this study was to evaluate the effectiveness of an advanced CDSS, HIGEA, which generates alerts based on predefined clinical rules to identify patients at risk of an ADE. Methods A multidisciplinary team defined the system and the clinical rules focusing on medication errors commonly encountered in clinical practice. Four intervention programs were defined: (1) dose adjustment in renal impairment; (2) adjustment of anticoagulation/antiplatelet therapy; (3) detection of biochemical/hematologic toxicities; and (4) therapeutic drug monitoring. We performed a 6-month observational prospective study to analyze the effectiveness of these clinical rules by calculating the positive predictive value (PPV). Results The team defined 211 clinical rules. During the study period, HIGEA generated 1,086 alerts (8.9 alerts per working day), which were reviewed by pharmacists. Fifty-one percent (554/1,086) of alerts generated an intervention to prevent a possible ADE; of these, 66% (368/554) required a documented modification to therapy owing to a real prescription error intercepted. The intervention program that induced the highest number of modifications to therapy was the dose adjustment in renal impairment program (PPV = 0.51), followed by the adjustment of anticoagulation/antiplatelet therapy program (PPV = 0.24). The percentage of accepted interventions was similar in surgical units (68%), medical units (67%), and critical care units (63%). Conclusion Our study offers evidence that HIGEA is highly effective in preventing potential ADEs at the prescription stage.

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“…1 EHRs routinely support patient safety by checking for drug allergies, drug-drug interactions, appropriate drug dosages, and duplicate orders. 2 Oftentimes, this support comes in the form of interruptive alerts that help prevent a user from doing the wrong thing. However, there is another approach.…”

Section: Background and Significancementioning

confidence: 99%

Getting Beyond Interruptive Alerts: Reducing Unintentional Duplicate Orders using a Visual Aid

Horng

Calder

et al. 2019

Preprint

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Word Count: 177/275ABSTRACT Background: EHRs allow teams of clinicians to simultaneously care for patients but an unintended consequence could result in duplicate ordering of tests and medications. We implemented a simple reminder for busy teams of clinicians in our emergency department by placing a red highlight around the checkbox of a computer-based order if previously ordered.Methodology: We performed an interrupted time series to analyze all patient visits 1 year before and 1 year after the intervention. Significance testing was performed using a negative binomial regression with Newey-West standard errors, correcting for patient level variables and environmental variables that might be associated with duplicate orders. The primary outcome measure was the number of unintentional duplicate orders.Results: After the intervention, the number of duplicate orders for laboratory orders decreased with an incidence rate ratio 0.63 (0.53-0.74) and for radiology orders decreased with an incidence rate ratio of 0.61 (0.45-0.83).Conclusion: Passive visual queues provide that provide just-in-time decision support are effective, not disruptive of workflow, and my decrease alert fatigue in busy clinical environments.

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Improving medication-related clinical decision support

Abstract: Standardization, integration of patient-specific parameters, and consideration of human factors design principles are central to realizing the potential benefits of medication-related CDS.

Cited by 75 publications

References 65 publications

Clinical Decision Support and Implications for the Clinician Burnout Crisis

Clinical Decision Support and Implications for the Clinician Burnout Crisis

Development and Evaluation of a Clinical Decision Support System to Improve Medication Safety

Getting Beyond Interruptive Alerts: Reducing Unintentional Duplicate Orders using a Visual Aid

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