Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System: A systematic...

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Patient Safety

Background:

• Computerized Provider Order Entry (CPOE) systems generate alerts to enhance medication safety.
• Alerts, such as dose range checks (DRC), drug-drug interactions, and drug-allergy warnings, can be excessive, leading to alert fatigue.
• Optimizing alert frequency is crucial for maintaining their effectiveness and preventing workarounds.

Purpose of the Study:

• To determine the frequency and types of decision support alerts in CPOE medication ordering.
• To analyze alert patterns by location and ordering provider role.
• To systematically adjust decision support tools to reduce alert volume.

Main Methods:

• Retrospective analysis of DRC, drug-drug interaction, and drug-allergy alerts from electronic medical records.
• Data collected during seven two-week sampling periods between April 2006 and October 2008.
• Audit of DRC alerts by provider role from November 2008 to January 2009; medication error counts from a voluntary reporting system.

Main Results:

• The percentage of medication orders triggering DRC alerts decreased from 23.9% to 7.4%.
• The percentage of medication orders triggering drug-drug interaction alerts decreased from 13.5% to 4.8%.
• Alerts decreased across all clinical areas without a rise in reported medication errors.

Conclusions:

• A systematic approach effectively reduced the quantity of decision support alerts in CPOE.
• Alert optimization was achieved without compromising patient safety, as evidenced by no increase in reported medication errors.