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.

Tópicos

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Resumo

JECTIVE: To develop and evaluate an electronic dashboard of hospital-wide electronic health record medication alerts for an alert fatigue reduction quality improvement project.METHODS: We used visual analytics software to develop the dashboard. We collaborated with the hospital-wide Clinical Decision Support committee to perform three interventions successively deactivating clinically irrelevant drug-drug interaction (DDI) alert rules. We analyzed the impact of the interventions on care providers' and pharmacists' alert and override rates using an interrupted time series framework with piecewise regression.RESULTS: We evaluated 2 391 880 medication alerts between January 31, 2011 and January 26, 2014. For pharmacists, the median alert rate prior to the first DDI deactivation was 58.74 alerts/100 orders (IQR 54.98-60.48) and 25.11 alerts/100 orders (IQR 23.45-26.57) following the three interventions (p<0.001). For providers, baseline median alert rate prior to the first round of DDI deactivation was 19.73 alerts/100 orders (IQR 18.66-20.24) and 15.11 alerts/100 orders (IQR 14.44-15.49) following the three interventions (p<0.001). In a subgroup analysis, we observed a decrease in pharmacists' override rates for DDI alerts that were not modified in the system from a median of 93.06 overrides/100 alerts (IQR 91.96-94.33) to 85.68 overrides/100 alerts (IQR 84.29-87.15, p<0.001). The medication serious safety event rate decreased during the study period, and there were no serious safety events reported in association with the deactivated alert rules.CONCLUSIONS: An alert dashboard facilitated safe rapid-cycle reductions in alert burden that were temporally associated with lower pharmacist override rates in a subgroup of DDIs not directly affected by the interventions; meanwhile, the pharmacists' frequency of selecting the 'cancel' option increased. We hypothesize that reducing the alert burden enabled pharmacists to devote more attention to clinically relevant alerts.

Resumo Limpo

jectiv develop evalu electron dashboard hospitalwid electron health record medic alert alert fatigu reduct qualiti improv projectmethod use visual analyt softwar develop dashboard collabor hospitalwid clinic decis support committe perform three intervent success deactiv clinic irrelev drugdrug interact ddi alert rule analyz impact intervent care provid pharmacist alert overrid rate use interrupt time seri framework piecewis regressionresult evalu medic alert januari januari pharmacist median alert rate prior first ddi deactiv alert order iqr alert order iqr follow three intervent p provid baselin median alert rate prior first round ddi deactiv alert order iqr alert order iqr follow three intervent p subgroup analysi observ decreas pharmacist overrid rate ddi alert modifi system median overrid alert iqr overrid alert iqr p medic serious safeti event rate decreas studi period serious safeti event report associ deactiv alert rulesconclus alert dashboard facilit safe rapidcycl reduct alert burden tempor associ lower pharmacist overrid rate subgroup ddis direct affect intervent meanwhil pharmacist frequenc select cancel option increas hypothes reduc alert burden enabl pharmacist devot attent clinic relev alert

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