Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction

Strom, Brian L.; Schinnar, Rita; Aberra, Faten; Bilker, Warren B.; Hennessy, Sean; Leonard, Charles E.; Pifer, Eric

doi:10.1001/archinternmed.2010.324

Cited by 193 publications

(161 citation statements)

References 31 publications

(18 reference statements)

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“…It must be acknowledged however that with this opportunity also comes new threats to patient safety from prescribing and administration errors as well as potential de-skilling of healthcare professionals. [42][43][44] The judicious use of educational prompts may facilitate a sustained change in prescribing behaviour but this must be balanced against the recognised risk of "alert fatigue" and competing priorities for e-prescribing system functionality from other medical and surgical specialities. 45 Successful implementation of the proposed antimicrobial stewardship software features into e-prescribing systems will likely be contingent upon a variety of sociotechnical considerations including seamless integration into the prescribing workflow with minimal time penalties for end-users and full compatibility with existing NHS information technology hardware and software.…”

Section: Discussionmentioning

confidence: 99%

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Hand

Cumming

Hopkins

et al. 2016

J. Antimicrob. Chemother.

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SynopsisThe implementation of electronic prescribing and medication administration systems (EPMAs) is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). ObjectivesThis study aimed to identify software features within EPMAs that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. MethodsA questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann Whitney U test. ResultsResponses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). 59% of pharmacists had experience of EPMA in their hospitals compared to 35% of microbiologists. Pharmacists assigned higher priority to: indication prompt (p<0.001), allergy checker (p=0.003) treatment protocols (p=0.003), drug-indication mismatch alerts (p=0.031) and prolonged course alerts (p=0.041); and lower priority to a dose checker for adults (p=0.02) and an interaction checker (p<0.05), than microbiologists. A "soft stop" functionality was rated essential or a high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection (CDI), antimicrobial resistance and drug expenditure. ConclusionsThe survey demonstrates key differences in health professionals' opinions of different healthcare benefits of EPMA but a consensus of anticipated positive impact on patient safety and antimicrobial stewardship.

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Section: Discussionmentioning

confidence: 99%

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Hand

Cumming

Hopkins

et al. 2016

J. Antimicrob. Chemother.

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“…These have been shown to be more likely to effect change on the physician documentation level but tend to aggravate physicians and may lead to delay in ordering necessary medications. 11 For example, one study evaluated the effect of a "hard stop" within the emergency department that was designed to increase the rate of human immunodeficiency virus (HIV) testing. This hard stop, which was linked with an HIV order set to obtain laboratory studies for patients, increased documentation of offering HIV testing drastically, although it only led to a modest increase in the percentage of patients who actually were tested for HIV (1.9% preversus 5.8% postintervention).…”

Section: Discussionmentioning

confidence: 99%

Effect of educational and electronic medical record interventions on food allergy management

Zelig

Harwayne‐Gidansky²,

Gault³

et al. 2016

allergy asthma proc

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“…Researchers have shown that electronic health records (EHR), computerized prescription order entry (CPOE) technologies and e-pharmacy are very beneficial in error and cost minimization, dispensing high-alert medications, and improved patient outcomes; [39][40][41][42] while some reports show mixed benefits. [26,43] These technologies if made available in our practice setting would minimize errors and uncertainty, and enhance quality of care to the patients.…”

Section: Discussionmentioning

confidence: 99%

Dispensing errors and uncertainty: Perspectives of pharmacists in a tertiary health facility in Lagos, Nigeria

Anyika

Omosebi

2015

JHA

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Introduction: Dispensing errors (DE) and health care uncertainty impact on health outcomes in a variety of ways. The aim of initiating therapy is to enhance patient wellness but human error probabilities sometimes cause harm or even fatalities and litigations. Objective: The aims of this study are to discuss the underlying factors in dispensing errors, health care uncertainty and therapeutic outcomes, and to identify the extent of human-and system-based sources of errors by exploring hospital pharmacists' attitudes and dispositions to DE and uncertainties; and the implications for patient safety in a tertiary hospital. Methods: The study involved a sample of 44 pharmacists who were administered a survey research inventory designed to assess pharmacists' attitudes and involvement in DE and uncertainty on a variety of important dimensions. Results: Overall the survey research data showed high rating of five human-based dimensions that would minimize dispensing errors, two human-system based, while three system-based (structural) issues were rated as dimensions that would aggravate DE in uncertain health care scenarios. Conclusions: The practical importance of the results for pharmacy practice and therapeutic outcomes are discussed and some suggestions made on how to minimize DE and uncertainty and the policy implications in the hospital pharmacy setting.

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Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction

Abstract: clinicaltrials.gov Identifier: NCT00870298.

Cited by 193 publications

References 31 publications

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

Effect of educational and electronic medical record interventions on food allergy management

Dispensing errors and uncertainty: Perspectives of pharmacists in a tertiary health facility in Lagos, Nigeria

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