AMDIS Case ConferenceIntrusive Medication Safety Alerts
23 March 2010
accepted: 25 March 2010
16 December 2017 (online)
Clinical decision support that provides enhanced patient safety at the point of care frequently encounters significant pushback from clinicians who find the process intrusive or time-consuming. We present a hypothetical medical center’s dilemma about its allergy alerting system and discuss similar problems faced by real hospitals. We then share some lessons learned and best practices for institutions who wish to implement these tools themselves.
- 1 Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW. et al. What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior?. J Am Med Inform Assoc 2009; 16: 531-538. PubMed PMID: 19390110.
- 2 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success.. BMJ 2005; 330: 765-72. PubMed PMID: 15767266.
- 3 Classen DC. Clinical decision support systems to improve clinical practice and quality of care.. JAMA 1998; 280: 1360-1361. PubMed PMID: 9794318.
- 4 Johnson KB, FitzHenry F. Case report: activity diagrams for integrating electronic prescribing tools into clinical workflow.. J Am Med Inform Assoc 2006; 13: 391-395. PubMed PMID: 16622168.
- 5 Hsieh TC, Kuperman GJ, Jaggi T, Hojnowski-Diaz P, Fiskio J, Williams DH. et al. Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system.. J Am Med Inform Assoc 2004; 11: 482-91. PubMed PMID: 15298998.
- 6 Teich JM, Osheroff JA, Pifer EA, Sittig DF, Jenders RA. Clinical decision support in electronic prescribing: recommendations and an action plan.. J Am Med Inform Assoc 2005; 12: 365-376. PubMed PMID: 15802474.
- 7 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors.. J Am Med Inform Assoc 2004; 11: 104-112. PubMed PMID: 14633936.
- 8 Karsh BT. Beyond usability: designing effective technology implementation systems to promote patient safety.. Qual Saf Health Care 2004; 13: 388-394. PubMed PMID: 15465944.
- 9 Piechowski R. Making CPOE work: redesign workflows to optimize benefits.. PSQH. 2006 Mar/Apr [Cited 2009 Dec 16]; [about 2p.]. Available from http://www.psqh.com/marapr06/cpoe.html.
- 10 Kaplan B, Harris-Salamone KD. Health IT success and failure: recommendations from literature and an AMIA workshop.. J Am Med Inform Assoc 2009; 16: 291-299. PubMed PMID: 19261935.
- 11 van der Sijs H, Aarts J, van Gelder T, Berg M, Vulto A. Turning off frequently overridden drug alerts: limited opportunities for doing it safely.. J Am Med Inform Assoc 2008; 15: 439-448. PubMed PMID: 18436915.
- 12 Osheroff JA. (editor). Improving medication use and outcomes with clinical decision support: a step-by-step guide, 1st ed.. Chicago: HIMSS; 2009. p. 2
- 13 Schreiber R, Knapp J. Premature condemnation of clinical decision support as a useful tool for patient safety in computerized provider order entry.. J Am Ger Soc 2009; 57: 1941-1942. PubMed PMID: 19807798.
- 14 Miller RA, Waitman LR, Chen S, Rosenbloom ST. The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt.. J Bio Inform 2005; 38: 469-485. PubMed PMID: 16290243.
- 15 Schreiber R. Case Study: Successful integration of Zynx order sets into Eclipsys CPOE at Holy Spirit Health System [Internet].. Santa Monica: Zynx, Inc; 2008 [Cited 2009 Dec 16] Available from http://www.zynxhealth.com/Newsletters/EyeOnZynx/20080804/Features/CaseStudy/HolySpirit.htm.