Quality of drug interaction alerts in prescribing and dispensing software

Sweidan, Michelle; Reeve, James F; Brien, Jo‐anne E; Jayasuriya, Pradeep; Martin, Jennifer H.; Vernon, Graeme M

doi:10.5694/j.1326-5377.2009.tb02832.x

Cited by 9 publications

(12 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Programs that display 2-drug alerts are unable to assess multidrug combinations simultaneously, and have varying degrees of sensitivity and specificity. 7,8 The resulting uncertainty, inaccuracy, and information overload has led to the phenomenon of "fatigue alert" or "pop-up fatigue" for clinicians verifying orders, further limiting the assessment of multidrug potential CYP-mediated DDIs in patients with polypharmacy. 9, 10 Until recently there was no simple way to make intelligent predictions about the likelihood or severity of clinically important multidrug potential CYP-mediated DDIs in older adults with polypharmacy.…”

mentioning

confidence: 99%

Prevalence and Risk of Potential Cytochrome P450–Mediated Drug-Drug Interactions in Older Hospitalized Patients with Polypharmacy

et al. 2013

View full text Add to dashboard Cite

The prevalence of potential CYP-mediated DDIs is high in geriatric patients with polypharmacy. The risk of DDIs increases as a function of the number of medications dispensed. Pharmacists' decision to intervene for potential CYP-mediated DDIs depends on clinical judgment in addition to the output from drug alert software programs, but may be facilitated by a single multicomponent, multidrug potential CYP-mediated DDI assessment.

show abstract

mentioning

confidence: 99%

Prevalence and Risk of Potential Cytochrome P450–Mediated Drug-Drug Interactions in Older Hospitalized Patients with Polypharmacy

et al. 2013

View full text Add to dashboard Cite

show abstract

“…By contrast, clinicians in dermatological settings override drug allergy alerts because they display irrelevant information that does not support decision‐making. This condition shows that the usefulness of alerts varies among clinicians and possibly across clinical specialties while providing relevant information that addresses patients' actual conditions (ie, diagnosis, allergies, demographics, and interactions), which can reduce alert overrides and improve alert adherence 30,31 . Overriding default options before completing prescriptions has increased workflow disruption in dermatological settings.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the appropriateness of clinical decision support alerts: A case study

Olakotan

Yusof

2020

Evaluation Clinical Practice

View full text Add to dashboard Cite

Rationale, aims, and objectives Clinical decision support (CDS) generates excessive alerts that disrupt the workflow of clinicians. Therefore, inefficient clinical processes that contribute to the misfit between CDS alert and workflow must be evaluated. This study evaluates the appropriateness of CDS alerts in supporting clinical workflow from a socio‐technical perspective. Method A qualitative case study evaluation was conducted at a 620‐bed public teaching hospital in Malaysia using interview, observation, and document analysis to investigate the features and functions of alert appropriateness and workflow‐related issues in cardiological and dermatological settings. The current state map for medication prescribing process was also modelled to identify problems pertinent to CDS alert appropriateness. Results The main findings showed that CDS was not well designed to fit into a clinician's workflow due to influencing factors such as technology (usability, alert content, and alert timing), human (training, perception, knowledge, and skills), organizational (rules and regulations, privacy, and security), and processes (documenting patient information, overriding default option, waste, and delay) impeding the use of CDS with its alert function. We illustrated how alert affect workflow in clinical processes using a Lean tool known as value stream mapping. This study also proposes how CDS alerts should be integrated into clinical workflows to optimize their potential to enhance patient safety. Conclusion The design and implementation of CDS alerts should be aligned with and incorporate socio‐technical factors. Process improvement methods such as Lean can be used to enhance the appropriateness of CDS alerts by identifying inefficient clinical processes that impede the fit of these alerts into clinical workflow.

show abstract

“… 48 This method of classification has already been shown to lack reproducible results so that different commercial systems will generate different subsets of alerts within these categories. 52 53 Empirically estimating the probability of adverse effects in different subpopulations provides a more meaningful clinical metric that could be used to establish alert thresholds. In this study, physicians were more likely to alter treatment when the overall risk of injury was high, and, conversely, physicians were less likely to respond when the risk was low.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial

Tamblyn

Eguale

Buckeridge

et al. 2012

Journal of the American Medical Informatics Association

View full text Add to dashboard Cite

ContextComputerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk.ObjectiveTo determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people.DesignCluster randomized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication.InterventionIntervention physicians received information about patient-specific risk of injury computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses. Risk thermometers presented changes in absolute and relative risk with each change in drug treatment. Control physicians received commercial drug alerts.Main outcome measuresInjury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors. Electronic health records and provincial insurance administrative data were used to measure outcomes.ResultsMean patient age was 75.2 years. Baseline risk of injury was 3.94 per 100 patients per year. Intermediate-acting benzodiazepines (56.2%) were the most common psychotropic drug. Intervention physicians reviewed therapy in 83.3% of visits and modified therapy in 24.6%. The intervention reduced the risk of injury by 1.7 injuries per 1000 patients (95% CI 0.2/1000 to 3.2/1000; p=0.02). The effect of the intervention was greater for patients with higher baseline risks of injury (p<0.03).ConclusionPatient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people.Trial registration numberclinicaltrials.gov Identifier: NCT00818285.

show abstract

Quality of drug interaction alerts in prescribing and dispensing software

Cited by 9 publications

References 3 publications

Prevalence and Risk of Potential Cytochrome P450–Mediated Drug-Drug Interactions in Older Hospitalized Patients with Polypharmacy

Prevalence and Risk of Potential Cytochrome P450–Mediated Drug-Drug Interactions in Older Hospitalized Patients with Polypharmacy

Evaluating the appropriateness of clinical decision support alerts: A case study

The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial

Contact Info

Product

Resources

About