Reduced Verification of Medication Alerts Increases Prescribing Errors.

Area of Science:

• Medical Informatics
• Patient Safety
• Human Factors Engineering

Background:

• Clinicians must ensure prescription safety, often using drug references for verification.
• Overreliance on decision support in other fields is linked to errors due to reduced verification.
• The impact of clinical decision support (CDS) on verification behaviors and prescribing errors in medicine is not well understood.

Purpose of the Study:

• To investigate the relationship between verification behaviors and prescribing errors.
• To determine if this relationship is influenced by the presence and accuracy of CDS medication alerts.
• To examine the mediating role of task complexity in this relationship.

Main Methods:

• 120 medical students used a simulated electronic prescribing system.
• Prescribing tasks involved varying levels of CDS (correct, incorrect, none) and task complexity (low, high).
• Outcomes measured were omission and commission errors, with verification assessed by drug reference access and view time.

Main Results:

• Failure to access drug references increased omission and commission errors, particularly with incorrect CDS.
• Fewer references were accessed with incorrect CDS compared to no CDS.
• Lower reference view time percentages correlated with increased omission and commission errors.
• CDS use, regardless of accuracy, was associated with reduced verification time.

Conclusions:

• Clinical decision support (CDS) can reduce prescription safety verification.
• When CDS provides incorrect alerts, reduced verification is associated with more prescribing errors.
• System design should support verification without compromising CDS benefits or increasing workload.