Prioritizing drug alerts could improve effectiveness of CPOE

Physicians often feel that computerized physician order entry systems with computerized decision support are basically crying wolf by issuing too many unimportant adverse drug event alerts, causing many to defeat the purpose by overriding the alert function, a new study reports.

In the study published online this week in BMC Medical Informatics and Decision Making, researchers theorized that alert overload could be minimized if drug safety alerts were tailored to specific clinical situations. They set out to see what type of context physicians would need to prioritize drug safety alerts.

More than 230 physicians surveyed at four European hospitals identified four factors that could be used to filter out low-priority alerts, selected from a potential list of 20. They are, in order:

  • Severity of the effect;
  • Clinical status of the patient;
  • Complexity of the case; and
  • Risk factors of the patient.

The researchers noted that all but one of the four factors--severity of the effect--involved patient-related data. Incorporating that information into CPOE/CDS systems would require access to highly structured patient and case information including diagnosis, drugs, lab results, allergies, medical procedures and orders, they said.

The CPOE module also would have to vary how alerts are displayed based on their ranking on the priority list, the researchers said.

The jury is still out on the effectiveness of CPOE in preventing adverse drug events. A study recently published in the Journal of General Internal Medicine found that while CPOEs reduced ADEs by 34 percent at five community hospitals, the number of potential ADEs rose by 29.5 percent.

To learn more:
- read the abstract
- here's a link to the full article (.pdf)

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