How hard or soft should a computerized physician order entry alert be?
The answer seems to be a moving target.
At first, soft order alerts were supposed to pop up on the computer screen to help alert clinicians to potential problems associated with specific prescription orders. They also were supposed to offer other treatment options, according to researchers involved in a study published in the Archives of Internal Medicine. But clinicians have been quick to override these soft alerts.
That led the researchers to hypothesize that a hard stop-order alert would be more effective and safer for patients. When a "hard stop alert" appears on the screen, the clinician's order is blocked to avert potentially serious reactions.
According to the recent study, the computerized "stop" was quite good at stopping orders for a dangerous drug combination--the anti-clotting drug warfarin and a certain antibiotic that can produce hazardous effects when taken together.
In fact, the stop alerts were a little too good: They had the unintended consequence of delaying treatment for four patients who were rare cases that could have benefited from immediate treatment through the risky drug combo.
The computerized stop "worked extremely well, but putting it in place actually hurt people," Brian Strom, a professor of public health and preventive medicine in biostatistics and epidemiology at the University of Pennsylvania School of Medicine and lead author of the study, told the Wall Street Journal's Health Blog.
"An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing," the study authors wrote. "However, this intervention precipitated clinically important treatment delays in four patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits."
The researchers decided to terminate the study prematurely, because it would have been unethical to continue.
To learn more:
- read the abstract in the Archives of Internal Medicine
- see the accompanying commentary from the Archives of Internal Medicine (subscription required)
- read the Wall Street Journal Health Blog post
- here's the Medscape article
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