We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Renal medication-related clinical decision support (CDS) alerts and overrides in the inpatient setting following implementation of a commercial electronic health record: implications for designing more effective alerts.
- Authors
Shah, Sonam N; Amato, Mary G; Garlo, Katherine G; Seger, Diane L; Bates, David W
- Abstract
<bold>Objective: </bold>To assess the appropriateness of medication-related clinical decision support (CDS) alerts associated with renal insufficiency and the potential/actual harm from overriding the alerts.<bold>Materials and Methods: </bold>Override rate frequency was recorded for all inpatients who had a renal CDS alert trigger between 05/2017 and 04/2018. Two random samples of 300 for each of 2 types of medication-related CDS alerts associated with renal insufficiency-"dose change" and "avoid medication"-were evaluated by 2 independent reviewers using predetermined criteria for appropriateness of alert trigger, appropriateness of override, and patient harm.<bold>Results: </bold>We identified 37 100 "dose change" and 5095 "avoid medication" alerts in the population evaluated, and 100% of each were overridden. Dose change triggers were classified as 12.5% appropriate and overrides of these alerts classified as 90.5% appropriate. Avoid medication triggers were classified as 29.6% appropriate and overrides 76.5% appropriate. We identified 5 adverse drug events, and, of these, 4 of the 5 were due to inappropriately overridden alerts.<bold>Conclusion: </bold>Alerts were nearly always presented inappropriately and were all overridden during the 1-year period studied. Alert fatigue resulting from receiving too many poor-quality alerts may result in failure to recognize errors that could lead to patient harm. Although medication-related CDS alerts associated with renal insufficiency had previously been found to be the most clinically beneficial alerts in a legacy system, in this system they were ineffective. These findings underscore the need for improvements in alert design, implementation, and monitoring of alert performance to make alerts more patient-specific and clinically appropriate.
- Subjects
ELECTRONIC health records; DRUG side effects; KIDNEY failure; LEGACY systems; MEDICAL informatics
- Publication
Journal of the American Medical Informatics Association, 2021, Vol 28, Issue 6, p1081
- ISSN
1067-5027
- Publication type
journal article
- DOI
10.1093/jamia/ocaa222