Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

Scott, Gregory; Shah, Priya; Wyatt, Jeremy; Makubate, Boikanyo; Cross, F. W.

doi:10.1136/amiajnl-2011-000199

Cited by 56 publications

(49 citation statements)

References 33 publications

(18 reference statements)

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“…Other approaches could be possible as well. For example, we rigorously avoided the forcing function approach, but that approach has shown benefit in studies of medication safety prompting systems 24,25 even though it also leads to high override rates. 26 As another example, a recent Cochrane review 1 found that computer-generated reminders delivered on paper were effective in changing practice and that providing space for physicians to respond led to greater effect size; including an explanation of the reminder, however, which we avoided, also improved effect size.…”

Section: Discussionmentioning

confidence: 99%

Clinical Reminders Designed and Implemented Using Cognitive and Organizational Science Principles Decrease Reminder Fatigue

Green¹,

Nease²,

Klinkman³

2015

The Journal of the American Board of Family Medicine

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Background:Response rates to point-of-care clinical reminders typically decrease over time. We hypothesized that this "reminder fatigue" could be prevented by (1) applying sound human factors engineering and cognitive science principles in designing the reminder system, and (2) implementing the reminders with rigorous attention to organizational science principles.Methods: This was a retrospective cohort enumeration from January 1, 2006, through July 31, 2012, in a set of 5 academically affiliated family medicine practices. We modeled the odds ratio of clinician action in response to a reminder according to the number of reminders issued during the encounter, the number of problems on the patient's problem list, patient age, and time (number of months since launch) using logistic regression with clustering by encounter.Results: There were issued 988,149 reminders at 453,537 encounters during the sampling frame. Action was taken in response to 60.1% of reminders, and discussion or consideration was documented in another 26.8%. The odds ratios for action in response to reminders over time, by number of prompts during the encounter, and by number of problems were 1.01, 1.18, and 1.02, respectively. Key design features included issuing reminders only when a service was due, allowing clinicians to attend to reminders when doing so fit their workflow (vs forcing attention at a specific time), keeping reminders very short and simple (action item only, no explicative material), and a team meeting and buy-in process before each new reminder was implemented.

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Section: Discussionmentioning

confidence: 99%

Clinical Reminders Designed and Implemented Using Cognitive and Organizational Science Principles Decrease Reminder Fatigue

Green¹,

Nease²,

Klinkman³

2015

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

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“…CDSSs for medication management can have beneficial effects such as reduction in medication errors, but results are varying [16][17][18][19][20]. Effects of a CDSS can be related to factors such as implementation, design, and clinical relevance of alerts [10,[21][22][23][24][25]. An excessive amount of alerts can cause alert fatigue which may result in alert overrides, i.e.…”

Section: Introductionmentioning

confidence: 99%

Potential drug-related problems detected by electronic expert support system: physicians’ views on clinical relevance

Hammar

Lidström²,

Petersson

et al. 2015

Int J Clin Pharm

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“…131 Qualitative methods such as simulations can provide insight into possible mechanisms of action of digital interventions, including factors to do with design and delivery, which can impact on uptake and engagement and, therefore, effectiveness. 262 Qualitative observation in practice can help to assess patterns of engagement and implementation and to discover unanticipated adverse effects of interventions. 169 …”

Section: Qualitative Process Evaluationsmentioning

confidence: 99%

Sexual health promotion for young people delivered via digital media: a scoping review

et al. 2015

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BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.

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Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

Abstract: Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes.

Cited by 56 publications

References 33 publications

Clinical Reminders Designed and Implemented Using Cognitive and Organizational Science Principles Decrease Reminder Fatigue

Clinical Reminders Designed and Implemented Using Cognitive and Organizational Science Principles Decrease Reminder Fatigue

Potential drug-related problems detected by electronic expert support system: physicians’ views on clinical relevance

Sexual health promotion for young people delivered via digital media: a scoping review

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