Effectiveness of Interruptive Clinical Decision Support Alerts on Intravenous versus Oral Acetaminophen Prescribing

Intravenous (IV) and oral acetaminophen have equivalent bioavailability and effectiveness, but IV formulations are significantly more expensive. Clinical decision support (CDS) tools can encourage cost-effective prescribing. We evaluated the effectiveness and acceptability of different CDS strategies on prescribing patterns of acetaminophen.

We conducted a two-arm randomized controlled trial with a historical comparator at our academic medical center, including 23,676 acetaminophen orders for 13,139 adult inpatients between July 2023 and November 2024. In the preintervention period, providers received a single-click interruptive alert when ordering IV acetaminophen. In the postperiod, providers were randomized to either a multiclick interruptive alert or no alert. The primary outcome was alert effectiveness; secondary outcomes included acceptability and durability.

The mean patient age was 57 years; 64% were female, 62% White, and 87% English-speaking. Most orders were placed for medicine (32%), primarily by residents (61%). Preintervention, 9.4% of orders were for IV acetaminophen, compared with 11.2% in the multiclick interruptive group and 12.1% in controls (p = 0.153). Among 624 interruptive alerts followed by orders, 24.5% switched to oral. Interrupted time series analysis showed no significant change in IV order trends.

Approximately one-quarter of multiclick alerts prompted a switch to oral acetaminophen, but overall effectiveness was no greater than the control or single-click alert. Findings suggest that increasing alert disruptiveness may add cognitive burden without meaningful gains in effectiveness. A multiclick interruptive alert did not significantly change IV acetaminophen prescribing. Effective CDS strategies may require minimally disruptive designs integrated with education.