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Alert override reasons: a failure to communicate
Amy E Chused1, Gilad J Kuperman, Peter D Stetson
1Department of Biomedical Informatics, Columbia University, New York, NY, USA.
AMIA ... Annual Symposium Proceedings. AMIA Symposium
|November 13, 2008
Summary
Many free text comments in computerized provider order entry (CPOE) systems are not override reasons. Over 5% of comments were misdirected, containing clinical instructions that were not seen by ordering clinicians, potentially causing communication failures.
Area of Science:
- Health Informatics
- Clinical Communication
- Patient Safety
Background:
- The Leapfrog Group's 2007 standard mandated reasons for overriding clinical alerts in computerized provider order entry (CPOE) systems.
- The use of free text comments alongside alerts presents an opportunity for clinician communication.
Purpose of the Study:
- To differentiate between actual override reasons and other forms of communication within free text comments in a CPOE system.
- To assess the impact of these comments on clinical communication and patient safety.
Main Methods:
- A review of 3583 free text comments submitted by clinicians responding to alerts in a CPOE system.
- Categorization of comments into override reasons, acknowledgments, content-free entries, and misdirected communication.
Main Results:
- 58% of comments were identified as valid override reasons.
- 28% were acknowledgments, 9% were content-free, and over 5% were misdirected.
- A significant portion of misdirected communication contained critical clinical instructions, not associated with orders.
Conclusions:
- Free text comments in CPOE systems are not exclusively used for alert override reasons.
- Misdirected clinical instructions within these comments pose a risk for communication failures.
- System design and user training may be needed to improve the clarity and effectiveness of CPOE communication.
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