Methods Inf Med 2021; 60(05/06): 180-184
DOI: 10.1055/s-0041-1735169
Short Paper

The Acceptance of Interruptive Medication Alerts in an Electronic Decision Support System Differs between Different Alert Types

Janina A. Bittmann
1  Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
2  Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
,
Elisabeth K. Rein
1  Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
2  Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
,
Michael Metzner
2  Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
,
Walter E. Haefeli
1  Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
2  Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
,
Hanna M. Seidling
1  Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
2  Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
› Author Affiliations
Funding None.

Abstract

Background Through targeted medication alerts, clinical decision support systems (CDSS) help users to identify medication errors such as disregarded drug–drug interactions (DDIs). Override rates of such alerts are high; however, they can be mitigated by alert tailoring or workflow-interrupting display of severe alerts that need active user acceptance or overriding. Yet, the extent to which the displayed alert interferes with the prescribers' workflow showed inconclusive impact on alert acceptance.

Objectives We aimed to assess whether and how often prescriptions were changed as a potential result of interruptive alerts on different (contraindicated) prescription constellations with particularly high risks for adverse drug events (ADEs).

Methods We retrospectively collected data of all interruptive alerts issued between March 2016 and August 2020 in the local CDSS (AiDKlinik) at Heidelberg University Hospital. The alert battery consisted of 31 distinct alerts for contraindicated DDI with simvastatin, potentially inappropriate medication for patients > 65 years (PIM, N = 14 drugs and 36 drug combinations), and contraindicated drugs in hyperkalemia (N = 5) that could be accepted or overridden giving a reason in free-text form.

Results In 935 prescribing sessions of 500 274 total sessions, at least one interruptive alert was fired. Of all interruptive alerts, about half of the sessions were evaluable whereof in total 57.5% (269 of 468 sessions) were accepted while 42.5% were overridden. The acceptance rate of interruptive alerts differed significantly depending on the alert type (p <0.0001), reaching 85.7% for DDI alerts (N = 185), 65.3% for contraindicated drugs in hyperkalemia (N = 98), and 25.1% for PIM alerts (N = 185).

Conclusion A total of 57.5% of the interruptive medication alerts with particularly high risks for ADE in our setting were accepted while the acceptance rate differed according to the alert type with contraindicated simvastatin DDI alerts being accepted most frequently.

Supplementary Material



Publication History

Received: 19 May 2021

Accepted: 12 July 2021

Publication Date:
27 August 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany