Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

Dekarske, Brian; Zimmerman, Christopher R.; Chang, Robert S.; Grant, Paul; Chaffee, Bruce W.

doi:10.1016/j.ijmedinf.2015.09.001

Cited by 22 publications

(29 citation statements)

References 11 publications

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“…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: 56%

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

Shin

Lee

et al. 2016

International Journal of Medical Informatics

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Section: Adherence To Alerts or Informationsupporting

confidence: 56%

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

Shin

Lee

et al. 2016

International Journal of Medical Informatics

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“…The possibility of customizing CDSS to increase alert specificity and alert acceptance has also been reported [ 61 ]. CDSS, where the severity levels for drug or disease interactions can be modified by the physician to exclude alerts at a level considered not relevant, or the use of an on-demand approach that provides decision support only when a physician considers it relevant, could improve alert acceptance [ 78 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review

Légat¹,

Laere²,

Nyssen³

et al. 2018

J Med Internet Res

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BackgroundWorldwide, the burden of allergies—in particular, drug allergies—is growing. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences; for example, a drug may be given to a patient with a documented allergy to that particular drug. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events.ObjectiveThe aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review.ResultsOf the 3160 articles considered, 60 met the inclusion criteria. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently.ConclusionsAccurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Als...

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“…The findings are particularly useful for CPOE designers and developers towards the construction of safer prescription systems. Dekarske et al [19] illustrated in a prospective, randomized crossover study, the increased appropriateness of customized alert acknowledgement explanations compared to non-customized configurations when overriding medication alerts in a CPOE system. The study pinpoints that poor application design or configuration can negatively affect provider behavior, when responding to important medication alerts.…”

Section: Discussion and Outlookmentioning

confidence: 99%

Computerized Clinical Decision Support: Contributions from 2015

Koutkias

Bouaud²

2016

Yearb Med Inform

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While there are notable examples of routinely used decision support systems, this 2015 review on CDSSs and CPOE systems still shows that, despite methodological contributions, theoretical frameworks, and prototype developments, these technologies are not yet widely spread (at least with their full functionalities) in routine clinical practice. Further research, testing, evaluation, and training are still needed for these tools to be adopted in clinical practice and, ultimately, illustrate the benefits that they promise.

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Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

Cited by 22 publications

References 11 publications

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

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

Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review

Computerized Clinical Decision Support: Contributions from 2015

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