Reducing Prescribing Errors Through Creatinine Clearance Alert Redesign

Melton, Brittany L.; Zillich, Alan J.; Russell, Scott A.; Weiner, Michael; McManus, M. Sue; Spina, Jeffrey R.; Russ, Alissa L.

doi:10.1016/j.amjmed.2015.05.033

Cited by 22 publications

(28 citation statements)

References 34 publications

(23 reference statements)

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“…Certainly human factors consideration was an important element in achieving the targets, similar to what has been suggested by several research studies involving technologybased applications. [12][13][14] The differences in compliance between the Spök and Engage highlight the importance of customization when employing a middleware, and demonstrate that not all middleware may function equally for a specific purpose. 15,16 During PDSA 3, ≥90% compliance was achieved for all CDI, and the target of 95% was reached for most CDI.…”

Section: Discussionmentioning

confidence: 99%

A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation

et al. 2016

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Handoffs for neonatal resuscitation involve communicating critical delivery information (CDI). The authors sought to achieve ≥95% communication of CDI during resuscitation team requests. CDI included name of caller, urgency of request, location of delivery, gestation of fetus, status of amniotic fluid, and indication for presence of the resuscitation team. Three interventions were implemented: verbal scripted handoff, Spök text messaging, and Engage text messaging. Percentages of CDI communications were analyzed using statistical process control. Following implementation of Engage, the communication of all CDI, except for indication, was ≥95%; communication of indication occurred 93% of the time. Control limits for most CDI were narrower with Engage, indicating greater reliability of communication compared to the verbal handoff and Spök. Delayed resuscitation team arrival, a countermeasure, was not higher with text messaging compared to verbal handoff (P = 1.00). Text messaging improved communication during high-risk deliveries, and it may represent an effective tool for other delivery centers.

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Section: Discussionmentioning

confidence: 99%

A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation

et al. 2016

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“…17 Usercentered design informed by simulated testing can lead to substantial design adjustments that ultimately improve adherence to evidence-based practices while reducing the user's cognitive workload. 7,18 In this study, the original electronic blood ordering process (original design, see ►Supplementary Figs. S1A-C and S2A and B; available in the online version) was initially redesigned by an internal multidisciplinary expert committee (design by expert committee; DEC, see ►Supplementary Fig.…”

Section: Background and Significancementioning

confidence: 99%

Formative Usability Testing Reduces Severe Blood Product Ordering Errors

et al. 2019

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Background Medical errors in blood product orders and administration are common, especially for pediatric patients. A failure modes and effects analysis in our health care system indicated high risk from the electronic blood ordering process. Objectives There are two objectives of this study as follows:(1) To describe differences in the design of the original blood product orders and order sets in the system (original design), new orders and order sets designed by expert committee (DEC), and a third-version developed through user-centered design (UCD).(2) To compare the number and type of ordering errors, task completion rates, time on task, and user preferences between the original design and that developed via UCD. Methods A multidisciplinary expert committee proposed adjustments to existing blood product order sets resulting in the DEC order set. When that order set was tested with front-line users, persistent failure modes were detected, so orders and order sets were redesigned again via formative usability testing. Front-line users in their native clinical workspaces were observed ordering blood in realistic simulated scenarios using a think-aloud protocol. Iterative adjustments were made between participants. In summative testing, participants were randomized to use the original design or UCD for five simulated scenarios. We evaluated differences in ordering errors, time on task, and users' design preference with two-sample t-tests. Results Formative usability testing with 27 providers from seven specialties led to 18 changes made to the DEC to produce the UCD. In summative testing, error-free task completion for the original design was 36%, which increased to 66% in UCD (30%, 95% confidence interval [CI]: 3.9–57%; p = 0.03). Time on task did not vary significantly. Conclusion UCD led to substantially different blood product orders and order sets than DEC. Users made fewer errors when ordering blood products for pediatric patients in simulated scenarios when using the UCD orders and order sets compared with the original design.

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“…These factors include the speed of the information system, timing of the alert (real time and at the point of care), minimal disruption of and integration into provider workflow, simplicity and clarity of the message, and provision of references and sufficient information within the alert. One study showed the positive effects of incorporating more user-friendly changes into a creatinine clearance alert system designed to reduce prescribing errors (21). The authors incorporated educational information, added links to additional laboratory information, and changed the timing of the alert to proximate the point of medical decision making, resulting in 43% fewer prescribing errors compared with the original alerts when tested by physicians in mock clinical scenarios.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Utility of Electronic Medical Record Alerts to Prevent Drug Nephrotoxicity

Martin

Wilson

2018

CJASN

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Nephrotoxin-induced AKI is an iatrogenic form of AKI that can be potentially avoided or ameliorated by prompt recognition and appropriate prescriber actions. Drug-targeted alerts, either for patients at risk of AKI or patients with existing AKI, may lead to more appropriate drug dosing and management and improved clinical outcomes. However, alerts of this type are complicated to create, have a high potential for error and off-target effects, and may be difficult to evaluate. Although many studies have shown that these alerts can reduce the rate of inappropriate prescribing, few studies have examined the utility of such alerts in terms of patient benefit. In this review, we examine the current state of the literature in this area, identify key technical challenges, and suggest methods of evaluation for drug-targeted AKI alerts.

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Reducing Prescribing Errors Through Creatinine Clearance Alert Redesign

Cited by 22 publications

References 34 publications

A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation

A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation

Formative Usability Testing Reduces Severe Blood Product Ordering Errors

Utility of Electronic Medical Record Alerts to Prevent Drug Nephrotoxicity

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