What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians' Prescribing Behavior?

Schedlbauer, Angela; Prasad, Vibhore; Mulvaney, Caroline; Phansalkar, Shobha; Stanton, Wendy; Bates, David W.; Avery, Anthony J

doi:10.1197/jamia.m2910

Cited by 216 publications

(163 citation statements)

References 37 publications

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“…One of the major perceived safety benefits of e-prescribing is CDS to aid with medication ordering 38 . However, the value of CDS is often limited by providers' lack of alert acceptance.…”

Section: Discussionmentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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BACKGROUND: Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems. OBJECTIVE: To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety. DESIGN, PARTICIPANTS: Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS. MAIN MEASUREMENTS: Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety. KEY RESULTS: We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2-54.8) and lowest one year postimplementation (12.2 per 100 prescriptions, 95% CI 8.6-17.4) (p<0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5-33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2-18.6) (p =0.337). Survey results complemented quantitative findings. CONCLUSIONS: Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits. INTRODUCTIONImproving healthcare safety is a national priority, and eprescribing is viewed as an important tool in these efforts 1-2 . Research on the ability of e-prescribing to improve safety has predominantly come from the inpatient setting and on locally developed systems created by organizations for their own use 3-5 . Fewer studies have been conducted on commercial systems or in the outpatient setting and results have been mixed [6][7][8][9][10][11][12][13] . To ensure that federal spending is directed toward effective interventions, it is important to evaluate the effect of e-prescribing on safety in the ambulatory setting, where most prescribing occurs and errors are common 7,[12][13][14][15] .Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet c...

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“…One of the major perceived safety benefits of e-prescribing is CDS to aid with medication ordering 38 . However, the value of CDS is often limited by providers' lack of alert acceptance.…”

Section: Discussionmentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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“…Many of these medication safety alerts have been built into EHR's to enhance patient safety. 13,14 However, few prior studies of computerized clinical-decision support have focused on improving warfarin monitoring. 15,16 To our knowledge, no prior studies have evaluated alerts targeted to accelerate monitoring in the specific clinical context of the coprescribing of warfarin and potentially interacting drugs.…”

Section: Discussionmentioning

confidence: 99%

“Stealth” Alerts to Improve Warfarin Monitoring When Initiating Interacting Medications

et al. 2012

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BACKGROUND: As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients prescribed a medication that could interact with warfarin. Instead of alerting the prescribing provider, the system notified a multidisciplinary anticoagulation management service, so that the prescribing clinicians never saw the alerts. We aimed to determine whether these "stealth" alerts increased the frequency of anticoagulation monitoring following the co-prescription of warfarin and a potentially interacting medication. METHODS: We conducted a pre-post intervention study, analyzed using an interrupted time-series, within a large, multispecialty group practice that uses a common EHR. The study included a 12-month period preceding the intervention, a 2-month period during intervention implementation, and a 6-month post-intervention period. The primary outcome measure was the proportion of patients completing anticoagulation monitoring within 5 days of a new co-prescribing event. RESULTS: Prior to implementation of the stealth alert, 34 % of patients completed anticoagulation monitoring within 5 days after the prescription of a medication with a potential warfarin interaction. After implementation of the alert, 39 % completed testing within 5 days (odds ratio 1.24, 95 % confidence interval 1.12-1.37). CONCLUSIONS: Stealth alerts increased the proportion of patients who underwent anticoagulation monitoring following the prescription of a medication that could potentially interact with warfarin. This team-based approach to clinical-decision support directs alerts away from prescribing clinicians and toward individuals who can directly implement them.

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“…Menekan kesalahan pengobatan, khususnya peresepan (potential/preventable adverse drug events), merupakan fungsi utama aplikasi sistem ini. 22 Hal ini erat kaitannya dengan kemudahan dan efisiensi serta efektivitas pelayanan yang diberikan yang ditunjukkan oleh kebiasaan dokter menggunakan aplikasi sistem CPOE ketika melakukan pelayanan medis terhadap pasien.…”

Section: Perilaku Pengentriunclassified

Sistem Peresapan Elektronik pada Keselamatan Pengobatan Pasien

Asyary

Kusnanto

Fuad

2013

Kesmas: National Public Health Journal

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AbstrakDalam banyak penerapannya, penggunaan sistem peresepan elektronik (computerized physician order entry, CPOE) dalam penulisan resep terbukti mampu menurunkan angka kesalahan peresepan obat (adverse drug event, ADE). Kesalahan pengobatan seperti kekeliruan penulisan nama obat, penentuan dosis, dan penggunaan jenis obat yang tepat untuk pasien dengan kondisi kesehatan tertentu di pelayanan kesehatan dapat ditekan. Namun, CPOE masih memiliki kelemahan seperti tambahan waktu untuk mengentri data pasien oleh para dokter ke dalam sistem. Untuk mengevaluasi dampak persepsi pengguna tentang penerapan CPOE terhadap keselamatan pengobatan pasien, suatu penelitian kualitatif telah dilakukan di Gadjah Mada Medical Health Center yang telah mengadopsi sistem ini selama sepuluh tahun. Data dan informasi dikumpukan dengan wawancara mendalam terhadap sembilan dokter (tujuh dokter umum dan dua dokter spesialis) sebagai informen pengguna CPOE menggunakan pedoman wawancara, alat perekam suara, buku catat, dan daftar centang observasi. Hasil studi menunjukkan bahwa sepuluh tahun CPOE telah mampu meningkatkan efektivitas dan efisiensi pelayanan kesehatan, tetapi potensi ADE masih terjadi akibat gangguan komunikasi pasien-dokter karena perlunya waktu tambahan untuk entri data. Disimpulkan bahwa sistem CPOE belum mampu mendukung pengambilan keputusan untuk mencegah ADE dalam pengobatan pasien.Kata kunci: Adverse drug event, computerized physician order entry, persepsi pengguna, keselamatan pasien, peresepan AbstractIn most of its applications, Computerized Physician Order Entry (CPOE) has been improved patient safety by reducing medication errors and subsequent adverse drug events (ADEs). Medication error such as elixir in writing, determination of dose, and correct drug type used for patient with certain health condition in health services can be reduced. But, the CPOE still has some weknesses such as additional time to entry the patient information by physician to the sistem. To evaluate the impact of end-user perception using CPOE sistem on patient safety medication, a qualitative research has been conducted at Gadjah Mada Medical Health Center which has adopted this sistem for ten years. Data and informations were collected by in-depth interviewing nine physicians (seven general docters and two specialists) as end-user informen using interview guide, tape recorder, notebook, and checklist observation tools. The results show that ten year CPOE implemention has improved the effectiveness and efficiency of medical health care, but potential adverse drug event (ADE) such as drug precription errors still occur as a result of patient-physician communication distraction due to additional time for data entry. It is concluded that CPOE sistem has not been able to support decision to prevent the ADEs in patient medication.Keywords: Adverse drug event, computerized physician order entry, enduser perception, patient safety, prescription PendahuluanKesalahan pengobatan (medication error) dapat terjadi di seluruh tingkat proses pengobatan,...

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What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians' Prescribing Behavior?

Cited by 216 publications

References 37 publications

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

“Stealth” Alerts to Improve Warfarin Monitoring When Initiating Interacting Medications

Sistem Peresapan Elektronik pada Keselamatan Pengobatan Pasien

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