J Am Med Inform Assoc - Overrides of medication-related clinical decision support alerts in outpatients.

Tópicos

{ medic(1828) order(1363) alert(1069) }
{ clinic(1479) use(1117) guidelin(835) }
{ can(774) often(719) complex(702) }
{ studi(2440) review(1878) systemat(933) }
{ cost(1906) reduc(1198) effect(832) }
{ search(2224) databas(1162) retriev(909) }
{ patient(1821) servic(1111) care(1106) }
{ measur(2081) correl(1212) valu(896) }
{ featur(3375) classif(2383) classifi(1994) }
{ chang(1828) time(1643) increas(1301) }
{ health(1844) social(1437) communiti(874) }
{ data(3963) clinic(1234) research(1004) }
{ research(1085) discuss(1038) issu(1018) }
{ model(2656) set(1616) predict(1553) }
{ process(1125) use(805) approach(778) }
{ imag(1947) propos(1133) code(1026) }
{ imag(1057) registr(996) error(939) }
{ network(2748) neural(1063) input(814) }
{ patient(2315) diseas(1263) diabet(1191) }
{ motion(1329) object(1292) video(1091) }
{ problem(2511) optim(1539) algorithm(950) }
{ case(1353) use(1143) diagnosi(1136) }
{ studi(1410) differ(1259) use(1210) }
{ ehr(2073) health(1662) electron(1139) }
{ patient(2837) hospit(1953) medic(668) }
{ result(1111) use(1088) new(759) }
{ implement(1333) system(1263) develop(1122) }
{ decis(3086) make(1611) patient(1517) }
{ model(3404) distribut(989) bayesian(671) }
{ data(1737) use(1416) pattern(1282) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ method(1219) similar(1157) match(930) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ take(945) account(800) differ(722) }
{ assess(1506) score(1403) qualiti(1306) }
{ treatment(1704) effect(941) patient(846) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ error(1145) method(1030) estim(1020) }
{ learn(2355) train(1041) set(1003) }
{ concept(1167) ontolog(924) domain(897) }
{ algorithm(1844) comput(1787) effici(935) }
{ extract(1171) text(1153) clinic(932) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ control(1307) perform(991) simul(935) }
{ model(2220) cell(1177) simul(1124) }
{ care(1570) inform(1187) nurs(1089) }
{ general(901) number(790) one(736) }
{ method(984) reconstruct(947) comput(926) }
{ featur(1941) imag(1645) propos(1176) }
{ howev(809) still(633) remain(590) }
{ risk(3053) factor(974) diseas(938) }
{ perform(999) metric(946) measur(919) }
{ system(1050) medic(1026) inform(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ monitor(1329) mobil(1314) devic(1160) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ data(2317) use(1299) case(1017) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ first(2504) two(1366) second(1323) }
{ intervent(3218) particip(2042) group(1664) }
{ activ(1138) subject(705) human(624) }
{ time(1939) patient(1703) rate(768) }
{ use(2086) technolog(871) perceiv(783) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ structur(1116) can(940) graph(676) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
{ survey(1388) particip(1329) question(1065) }
{ estim(2440) model(1874) function(577) }
{ activ(1452) weight(1219) physic(1104) }
{ method(1969) cluster(1462) data(1082) }
{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

CKGROUND: Electronic prescribing is increasingly used, in part because of government incentives for its use. Many of its benefits come from clinical decision support (CDS), but often too many alerts are displayed, resulting in alert fatigue.OBJECTIVE: To characterize the override rates for medication-related CDS alerts in the outpatient setting, the reasons cited for overrides at the time of prescribing, and the appropriateness of overrides.METHODS: We measured CDS alert override rates and the coded reasons for overrides cited by providers at the time of prescribing. Our primary outcome was the rate of CDS alert overrides; our secondary outcomes were the rate of overrides by alert type, reasons cited for overrides at the time of prescribing, and override appropriateness for a subset of 600 alert overrides. Through detailed chart reviews of alert override cases, and selective literature review, we developed appropriateness criteria for each alert type, which were modified iteratively as necessary until consensus was reached on all criteria.RESULTS: We reviewed 157,483 CDS alerts (7.9% alert rate) on 2,004,069 medication orders during the study period. 82,889 (52.6%) of alerts were overridden. The most common alerts were duplicate drug (33.1%), patient allergy (16.8%), and drug-drug interactions (15.8%). The most likely alerts to be overridden were formulary substitutions (85.0%), age-based recommendations (79.0%), renal recommendations (78.0%), and patient allergies (77.4%). An average of 53% of overrides were classified as appropriate, and rates of appropriateness varied by alert type (p<0.0001) from 12% for renal recommendations to 92% for patient allergies.DISCUSSION: About half of CDS alerts were overridden by providers and about half of the overrides were classified as appropriate, but the likelihood of overriding an alert varied widely by alert type. Refinement of these alerts has the potential to improve the relevance of alerts and reduce alert fatigue.

Resumo Limpo

ckground electron prescrib increas use part govern incent use mani benefit come clinic decis support cds often mani alert display result alert fatigueobject character overrid rate medicationrel cds alert outpati set reason cite overrid time prescrib appropri overridesmethod measur cds alert overrid rate code reason overrid cite provid time prescrib primari outcom rate cds alert overrid secondari outcom rate overrid alert type reason cite overrid time prescrib overrid appropri subset alert overrid detail chart review alert overrid case select literatur review develop appropri criteria alert type modifi iter necessari consensus reach criteriaresult review cds alert alert rate medic order studi period alert overridden common alert duplic drug patient allergi drugdrug interact like alert overridden formulari substitut agebas recommend renal recommend patient allergi averag overrid classifi appropri rate appropri vari alert type p renal recommend patient allergiesdiscuss half cds alert overridden provid half overrid classifi appropri likelihood overrid alert vari wide alert type refin alert potenti improv relev alert reduc alert fatigu

Resumos Similares

J Am Med Inform Assoc - Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients. ( 0,94412721317035 )
Telemed J E Health - Rural inpatient telepharmacy consultation demonstration for after-hours medication review. ( 0,941893425253644 )
J Am Med Inform Assoc - Errors associated with outpatient computerized prescribing systems. ( 0,941357318921717 )
J. Med. Internet Res. - Physician order entry or nurse order entry? Comparison of two implementation strategies for a computerized order entry system aimed at reducing dosing medication errors. ( 0,940242217700209 )
Appl Clin Inform - Response to medication dosing alerts for pediatric inpatients using a computerized provider order entry system. ( 0,938426588792366 )
J Am Med Inform Assoc - Factors contributing to an increase in duplicate medication order errors after CPOE implementation. ( 0,938316343747291 )
Comput Methods Programs Biomed - A smart medication recommendation model for the electronic prescription. ( 0,93688948270424 )
Int J Med Inform - Evaluation of medication dose alerts in pediatric inpatients. ( 0,936156942455545 )
Appl Clin Inform - Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System: A systematic approach to decrease alerts. ( 0,933828317087805 )
Comput Methods Programs Biomed - Physicians' responses to computerized drug-drug interaction alerts for outpatients. ( 0,933591809117138 )
J Am Med Inform Assoc - Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients. ( 0,932821770793247 )
J Am Med Inform Assoc - Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard. ( 0,932017936647695 )
J Am Med Inform Assoc - Failure to utilize functions of an electronic prescribing system and the subsequent generation of 'technically preventable' computerized alerts. ( 0,930405979169016 )
J Am Med Inform Assoc - A framework for evaluating the appropriateness of clinical decision support alerts and responses. ( 0,929413098015739 )
J Am Med Inform Assoc - Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system. ( 0,9281266184869 )
Int J Med Inform - Prescription order risk factors for pediatric dosing alerts. ( 0,927193124458219 )
J Am Med Inform Assoc - Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes. ( 0,924237502807676 )
J Am Med Inform Assoc - Don't fuel the fire: decreasing intravenous haloperidol use in high risk patients via a customized electronic alert. ( 0,919651632052278 )
J Med Syst - Two RFID-based solutions for secure inpatient medication administration. ( 0,919232420162949 )
J Am Med Inform Assoc - Understanding and preventing wrong-patient electronic orders: a randomized controlled trial. ( 0,916307974604727 )
AMIA Annu Symp Proc - Improving patient safety by modifying provider ordering behavior using alerts (CDSS) in CPOE system. ( 0,915060974940503 )
J Am Med Inform Assoc - Evaluating the accuracy of electronic pediatric drug dosing rules. ( 0,914844838955223 )
Int J Med Inform - Junior doctors' prescribing work after-hours and the impact of computerized decision support. ( 0,913639144564399 )
Appl Clin Inform - Drug interaction alert override rates in the Meaningful Use era: no evidence of progress. ( 0,911443365623413 )
J Am Med Inform Assoc - Prevalence of medication administration errors in two medical units with automated prescription and dispensing. ( 0,909791222878433 )
Int J Med Inform - The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan. ( 0,908410729498587 )
J Am Med Inform Assoc - Development and use of active clinical decision support for preemptive pharmacogenomics. ( 0,906096497724241 )
J Am Med Inform Assoc - Ambulatory prescribing errors among community-based providers in two states. ( 0,902573908561315 )
AMIA Annu Symp Proc - Improving Patient Safety through Medical Alert Management: An Automated Decision Tool to Reduce Alert Fatigue. ( 0,898564442354513 )
J Am Med Inform Assoc - Integrating pharmacogenetic information and clinical decision support into the electronic health record. ( 0,898324635542333 )
Appl Clin Inform - Duplicate orders: an unintended consequence of computerized provider/physician order entry (CPOE) implementation: analysis and mitigation strategies. ( 0,895084247483835 )
Appl Clin Inform - Effect of EHR user interface changes on internal prescription discrepancies. ( 0,894348556083979 )
Perspect Health Inf Manag - Enhance the accuracy of medication histories for the elderly by using an electronic medication checklist. ( 0,891651956889691 )
Int J Med Inform - A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation. ( 0,890502369889487 )
Int J Med Inform - Impact of a clinical decision support system for high-alert medications on the prevention of prescription errors. ( 0,89001712419931 )
J Am Med Inform Assoc - Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation. ( 0,889966997288881 )
AMIA Annu Symp Proc - Unexpected effects of unintended consequences: EMR prescription discrepancies and hemorrhage in patients on warfarin. ( 0,888955670854058 )
Comput Methods Programs Biomed - Developing guideline-based decision support systems using prot?g? and jess. ( 0,888107189783431 )
J Am Med Inform Assoc - Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors. ( 0,886640240342466 )
Int J Med Inform - Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists' analysis of medication orders in hospitals. ( 0,886117031527382 )
J Am Med Inform Assoc - Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE). ( 0,885951287689299 )
Perspect Health Inf Manag - Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? ( 0,882928597423265 )
J Am Med Inform Assoc - How to improve the delivery of medication alerts within computerized physician order entry systems: an international Delphi study. ( 0,88223582924739 )
Int J Med Inform - Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. ( 0,880400050840982 )
J Am Med Inform Assoc - Prescribers' expectations and barriers to electronic prescribing of controlled substances. ( 0,876933442443169 )
Int J Med Inform - Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. ( 0,875864663110514 )
Int J Med Inform - Technology-related medication errors in a tertiary hospital: a 5-year analysis of reported medication incidents. ( 0,874910332118638 )
Med Decis Making - Electronic notifications about drug substitutes can change physician prescription habits: a cross-sectional observational study. ( 0,866371535806308 )
Appl Clin Inform - Medication safety improves after implementation of positive patient identification. ( 0,863186933659026 )
J Am Med Inform Assoc - Classification of medication incidents associated with information technology. ( 0,862364101736752 )
J Am Med Inform Assoc - Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. ( 0,86234157805519 )
J Am Med Inform Assoc - Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system. ( 0,858977593797373 )
J Am Med Inform Assoc - A clinical data warehouse-based process for refining medication orders alerts. ( 0,855700652571169 )
Int J Med Inform - What, if all alerts were specific - estimating the potential impact on drug interaction alert burden. ( 0,855245383231438 )
J Am Med Inform Assoc - The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals. ( 0,854945974558009 )
AMIA Annu Symp Proc - An analysis and recommendations for multidisciplinary computerized handoff applications in hospitals. ( 0,854092990326818 )
J Med Syst - Development of a point-of-care HIV/AIDS medication dosing support system using the Android mobile platform. ( 0,853908054548345 )
AMIA Annu Symp Proc - I meant that med for Baylee not Bailey!: a mixed method study to identify incidence and risk factors for CPOE patient misidentification. ( 0,852408567074737 )
J Am Med Inform Assoc - A randomized-controlled trial of computerized alerts to reduce unapproved medication abbreviation use. ( 0,850581320034575 )
J Am Med Inform Assoc - Guided medication dosing for elderly emergency patients using real-time, computerized decision support. ( 0,839752564107227 )
BMC Med Inform Decis Mak - Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence. ( 0,836648865187337 )
Int J Med Inform - Comparing the working time between Bar-Code Medication Administration system and traditional medication administration system: an observational study. ( 0,834662075702103 )
AMIA Annu Symp Proc - Factors Contributing to CPOE Opiate Allergy Alert Overrides. ( 0,834261005590433 )
J Am Med Inform Assoc - Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. ( 0,83304110577443 )
Appl Clin Inform - Reducing risk with clinical decision support: a study of closed malpractice claims. ( 0,830254583700847 )
Med Decis Making - Better medicine by default. ( 0,82291938004635 )
Artif Intell Med - Evaluation of rule effectiveness and positive predictive value of clinical rules in a Dutch clinical decision support system in daily hospital pharmacy practice. ( 0,822454522638233 )
Methods Inf Med - From adverse drug event detection to prevention. A novel clinical decision support framework for medication safety. ( 0,820541799708802 )
BMC Med Inform Decis Mak - Development of a context model to prioritize drug safety alerts in CPOE systems. ( 0,820393518516939 )
Appl Clin Inform - Electronic medical record prompts for lab orders in patients initiating statins. ( 0,819952122842477 )
Appl Clin Inform - Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors. ( 0,819836826543614 )
BMC Med Inform Decis Mak - On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop. ( 0,818456254522905 )
Health Informatics J - Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial. ( 0,81675345042067 )
J Am Med Inform Assoc - 'Too much, too late': mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing. ( 0,814617295631442 )
AMIA Annu Symp Proc - Analyzing U.S. prescription lists with RxNorm and the ATC/DDD Index. ( 0,812211097058129 )
Int J Med Inform - Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan. ( 0,811851502270702 )
AMIA Annu Symp Proc - Effectiveness of bar coded medication alerts for elevated potassium. ( 0,810008426884893 )
AMIA Annu Symp Proc - Reducing wrong patient selection errors: exploring the design space of user interface techniques. ( 0,808109044629035 )
AMIA Annu Symp Proc - Ontological approach for safe and effective polypharmacy prescription. ( 0,807873510743812 )
Health Informatics J - Statistical classification of drug incidents due to look-alike sound-alike mix-ups. ( 0,807825519579443 )
J Am Med Inform Assoc - Impact of clinical decision support on receipt of antibiotic prescriptions for acute bronchitis and upper respiratory tract infection. ( 0,807302566513544 )
Int J Med Inform - Impact of electronic order management on the timeliness of antibiotic administration in critical care patients. ( 0,805482200644537 )
Int J Med Inform - Coded entry versus free-text and alert overrides: what you get depends on how you ask. ( 0,804157955881452 )
J Am Med Inform Assoc - Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance. ( 0,792927720371713 )
Artif Intell Med - Safety and usability evaluation of a web-based insulin self-titration system for patients with type 2 diabetes mellitus. ( 0,786630978375268 )
J Am Med Inform Assoc - Detecting pregnancy use of non-hormonal category X medications in electronic medical records. ( 0,7860463430944 )
AMIA Annu Symp Proc - Evaluating the effectiveness of clinical alerts: a signal detection approach. ( 0,783924592193351 )
Int J Med Inform - Evaluation of the pilot program on the real-time drug utilization review system in South Korea. ( 0,782728567356219 )
J Am Med Inform Assoc - Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support. ( 0,776914589007757 )
BMC Med Inform Decis Mak - Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model. ( 0,776047950531696 )
Comput Methods Programs Biomed - Potential drug-drug interactions in pediatric outpatient prescriptions for newborns and infants. ( 0,775668101038228 )
Artif Intell Med - Physicians' responses to clinical decision support on an intensive care unit--comparison of four different alerting methods. ( 0,773490002146571 )
Methods Inf Med - Attitude of physicians towards automatic alerting in computerized physician order entry systems. A comparative international survey. ( 0,771435351192094 )
J Telemed Telecare - Feasibility and accuracy of medication checks via Internet video. ( 0,770609027127288 )
AMIA Annu Symp Proc - Medical alert management: a real-time adaptive decision support tool to reduce alert fatigue. ( 0,77045709622687 )
J Am Med Inform Assoc - Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool. ( 0,767538633929399 )
BMC Med Inform Decis Mak - Evaluation of a drug-drug interaction: fax alert intervention program. ( 0,766439985651931 )
J Am Med Inform Assoc - The influence of computerized decision support on prescribing during ward-rounds: are the decision-makers targeted? ( 0,766403586474981 )
J Am Med Inform Assoc - Collaborative knowledge acquisition for the design of context-aware alert systems. ( 0,766169964451995 )
AMIA Annu Symp Proc - Reducing free-text communication orders placed by providers using association rule mining. ( 0,761442075006408 )