Int J Med Inform - Understanding handling of drug safety alerts: a simulation study.

Tópicos

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Resumo

RPOSE: To study correctness of drug safety alert handling and error type in a computerized physician order entry (CPOE) system in a simulated work environment.METHODS: Disguised observation study of 18 physicians (12 from internal medicine and 6 from surgery) entering 35 orders of predefined patient cases with 13 different drug safety alerts in a CPOE. Structured interviews about how the generated drug safety alerts were handled in the simulation test and resemblance of the test to the normal work environment. Handling and reasons for this were scored for correctness and error type.RESULTS: Thirty percent of alerts were handled incorrectly, because the action itself and/or the reason for the handling were incorrect. Sixty-three percent of the errors were categorized as rule based and residents in surgery used incorrect justifications twice as often as residents in internal medicine. They often referred to monitoring of incorrect substances or parameters. One alert presented as a second alert in one screen was unconsciously overridden several times. One quarter of residents showed signs of alert fatigue.CONCLUSION: Although alerts were mainly handled correctly, underlying rules and reasoning were often incorrect, thereby threatening patient safety. This study gave an insight into the factors playing a role in incorrect drug safety alert handling that should be studied in more detail. The results suggest that better training, improved concise alert texts, and increased specificity might help. Furthermore, the safety of the predefined override reason 'will monitor' and double alert presentation in one screen is questioned.

Resumo Limpo

rpose studi correct drug safeti alert handl error type computer physician order entri cpoe system simul work environmentmethod disguis observ studi physician intern medicin surgeri enter order predefin patient case differ drug safeti alert cpoe structur interview generat drug safeti alert handl simul test resembl test normal work environ handl reason score correct error typeresult thirti percent alert handl incorrect action andor reason handl incorrect sixtythre percent error categor rule base resid surgeri use incorrect justif twice often resid intern medicin often refer monitor incorrect substanc paramet one alert present second alert one screen unconsci overridden sever time one quarter resid show sign alert fatigueconclus although alert main handl correct under rule reason often incorrect therebi threaten patient safeti studi gave insight factor play role incorrect drug safeti alert handl studi detail result suggest better train improv concis alert text increas specif might help furthermor safeti predefin overrid reason will monitor doubl alert present one screen question

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