Biomaterial Database

Clinicians' assessments of electronic medication safety alerts in ambulatory care. 2009

Saul N Weingart, and Brett Simchowitz, and Lawrence Shiman, and Daniela Brouillard, and Adrienne Cyrulik, and Roger B Davis, and Thomas Isaac, and Michael Massagli, and Laurinda Morway, and Daniel Z Sands, and Justin Spencer, and Joel S Weissman

Center for Patient Safety, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA. saul_weingart@dfci.harvard.edu

BACKGROUND While electronic prescribing (e-prescribing) systems with drug interaction and allergy alerts promise to improve medication safety in ambulatory care, clinicians often override these safety features. We undertook a study of respondents' satisfaction with e-prescribing systems, their perceptions of alerts, and their perceptions of behavior changes resulting from alerts. METHODS Random sample survey of 300 Massachusetts ambulatory care clinicians who used a commercial e-prescribing system. RESULTS A total of 184 respondents completed the survey (61%). Respondents indicated that e-prescribing improved the quality of care delivered (78%), prevented medical errors (83%), and enhanced patient satisfaction (71%) and clinician efficiency (75%). In addition, 35% of prescribers said that electronic alerts caused them to modify a potentially dangerous prescription in the last 30 days. They suggested that alerts also led to other changes in clinical care: counseling patients about potential reactions (49% of respondents), looking up information in medical references (44%), and changing the way a patient was monitored (33%). Altogether, 63% of clinicians reported taking action other than discontinuing or modifying an alerted prescription in the previous month in response to alerts. Despite these benefits, fewer than half of respondents were satisfied with drug interaction and allergy alerts (47%). Problems included alerts triggered by discontinued medications (58%), alerts that failed to account for appropriate drug combinations (46%), and excessive volume of alerts (37%). CONCLUSIONS Although clinicians were critical of the quality of e-prescribing alerts, alerts may lead to clinically significant modifications in patient management not readily apparent based on "acceptance" rates.

UI	MeSH Term	Description	Entries
D007722	Health Knowledge, Attitudes, Practice	Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).	Knowledge, Attitudes, Practice
D008297	Male		Males
D008404	Massachusetts	State bounded on the north by New Hampshire and Vermont, on the east by the Atlantic Ocean, on the south by Connecticut and Rhode Island, and on the west by New York.
D010818	Practice Patterns, Physicians'	Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.	Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D010821	Physicians, Family	Those physicians who have completed the education requirements specified by the American Academy of Family Physicians.	Family Physician,Family Physicians,Physician, Family
D003258	Consumer Behavior	Behavior associated with the procurement of goods, services, or experiences.	Consumer Preference,Consumer Satisfaction,Behavior, Consumer,Behaviors, Consumer,Consumer Behaviors,Consumer Preferences,Preference, Consumer,Preferences, Consumer,Satisfaction, Consumer
D004342	Drug Hypersensitivity	Immunologically mediated adverse reactions to medicinal substances used legally or illegally.	Allergy, Drug,Hypersensitivity, Drug,Drug Allergy,Allergies, Drug,Drug Allergies,Drug Hypersensitivities,Hypersensitivities, Drug
D004347	Drug Interactions	The action of a drug that may affect the activity, metabolism, or toxicity of another drug.	Drug Interaction,Interaction, Drug,Interactions, Drug
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man