Opioid Prescribing Risk Factors in Nonoperative Ankle Fractures: The Impact of a Prospective Clinical Decision Support Intervention

Wohler, Andrew; Macknet, David M.; Seymour, Rachel B.; Wally, Meghan K.; Irwin, Todd A.; Hsu, Joseph R.; Beuhler, Michael C.; Bosse, Michael J.; Gibbs, Michael; Griggs, Christopher; Jarrett, Steven; Karunakar, Madhav A.; Kempton, Laurence B.; Leas, Daniel; Odum, Susan M.; Phelps, Kevin; Roomian, Tamar; Runyon, Michael S.; Saha, Animita; Sims, Stephen H.; Watling, Bradley; Wyatt, Stephen A.; Yu, Ziqing

doi:10.1053/j.jfas.2021.09.030

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…The discussion on electronic prescription alerts is only mapped to two impacts, namely reducing prescribing errors and improving compliance with protocols. [6], [7], [18], [24], [26], [29], [30], [35], [39], [43]- [46], [48], [49], [55] [31], [42] [2], [40], [41], [53] [5], [8], [19] CDSS and EHR (or other system) integration [34], [50], [52] [17], [47], [51] [33] [25] Electronic prescription alert [6], [11], [14], [18], [28], [32], [35], [36], [37], [38], [43], [46], [48], [49] [27], [54] --DDI [11], [14], [36], [37] ---…”

Section: Performance Indicatorsmentioning

confidence: 99%

“…CDSS is implemented in many hospitals to prevent medication errors and associated harm. Now, doctors are using CDSS more and more in many different areas, such as infection management [2], care for the elderly [3], [4], diabetes mellitus [5], chemotherapy [6], fractures [7], and cardiovascular [8]. However, the rarity of reported evaluations, as well as the high number of studies in the design or pilot phase, suggest that the use of this CDSS to support decision making is considered new and requires further study [9].…”

Section: Introductionmentioning

confidence: 99%

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Do clinical decision support systems for prescribing improve patient safety? a systematic literature review

Kusumadewi

Miladiyah

2023

IJEECS

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Clinical decision support systems (CDSS) are developed independently or connected to the electronic health record (EHR) or other computerized systems. The study begins with identification by searching the literature through the Google Scholar, PubMed and ScienceDirect databases. The search results obtained 5,595 articles. Forty-two articles were obtained, which were used further. Most of the research focus is on "CDSS development and evaluation". In terms of impacts, the most common is "reduce prescribing errors". One of the biggest problems reported was the presence of "alert fatigue," which was felt to be disturbing to doctors and pharmacists. CDSS must be supported by a method that is able to indicate the presence of drug-drug interactions (DDI). The use of alerts indicating the presence of a DDI should be interpreted using clinical judgment to determine the risks and benefits of a particular drug for a specific patient. The performance of CDSS is mostly reported to have been able to reduce prescribing errors, which in turn will improve patient safety. However, increased adherence to clinical protocols has not been widely reported. Complaints that are still quite a lot reported are the presence of "alert fatigue", which can interfere with effectiveness.

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Section: Performance Indicatorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Do clinical decision support systems for prescribing improve patient safety? a systematic literature review

Kusumadewi

Miladiyah

2023

IJEECS

View full text Add to dashboard Cite

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Opioid Prescribing Rate for Nonoperative Distal Radius Fractures and Clinician Response to a Clinical Decision Support Alert

Averkamp,

Li,

Wally

et al. 2024

The Journal of Emergency Medicine

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Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

et al. 2022

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Background and Objectives Posttraumatic stress disorder (PTSD) is associated with higher rates of chronic pain and increased risk of developing Opioid use disorder. This paper evaluates the impact of PRIMUM, an electronic health record‐embedded (EHR) clinical decision support intervention on opioid prescribing patterns for patients with diagnosis of PTSD. Methods Inpatient, emergency department (ED), urgent care, and outpatient encounters with ICD‐10 codes F43.1 (PTSD), F43.10 (PTSD, unspecified), F43.11 (PTSD, acute), and F43.12 (PTSD, chronic) at Atrium Health between 1/1/2016 and 12/29/2018 were included in the study. Results A total of 3121 patients with a diagnosis of PTSD were seen in 37,443 encounters during the study period. Ten percent (n = 3761) of the encounters resulted in prescriptions for opioids and PRIMUM alerts were triggered in 1488 of these encounters. These alerts resulted in “decision influenced” for 17% of patients (n = 255) or no prescriptions for opioids or benzodiazepines for 5.8% (n = 86). The majority of the prescriptions were below 50 Morphine milligram equivalents (MME)/day, but there were 570 (15.5%) prescriptions for doses of 50–90 MME and 721 (19.6%) prescriptions for >90 MME/day. Discussion and Conclusion The PRIMUM alert system helps improve patient safety. PRIMUM affected clinician decisions 17% of the time, and the effect was greater in patients with opioid overdose history and those presenting for early refills. Scientific Significance The effectiveness of clinical support interventions for opioid prescribing for patients with PTSD has not been documented previously. Our findings provide novel evidence that the EHR can be used to improve patient safety among patients with PTSD in the context of substance use.

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Opioid Prescribing Risk Factors in Nonoperative Ankle Fractures: The Impact of a Prospective Clinical Decision Support Intervention

Cited by 3 publications

References 21 publications

Do clinical decision support systems for prescribing improve patient safety? a systematic literature review

Do clinical decision support systems for prescribing improve patient safety? a systematic literature review

Opioid Prescribing Rate for Nonoperative Distal Radius Fractures and Clinician Response to a Clinical Decision Support Alert

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

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