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Am J Med. 2015 Oct;128(10):1117-25. doi: 10.1016/j.amjmed.2015.05.033. Epub 2015 Jun 16.

Reducing prescribing errors through creatinine clearance alert redesign.

Author information

1
School of Pharmacy, University of Kansas, Lawrence. Electronic address: bmelton2@kumc.edu.
2
Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind; Regenstrief Institute, Inc, Indianapolis, Ind; Indiana University Center for Health Services and Outcomes Research, Indianapolis; College of Pharmacy, Purdue University, West Lafayette, Ind.
3
Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind.
4
Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind; Regenstrief Institute, Inc, Indianapolis, Ind; Indiana University Center for Health Services and Outcomes Research, Indianapolis.
5
Department of Veterans Affairs, Nephrology Services Central Texas, Temple.
6
VA Greater Los Angeles Healthcare System, Los Angeles, Calif; David Geffen School of Medicine, University of California, Los Angeles.

Abstract

BACKGROUND:

Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts.

METHODS:

Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors.

RESULTS:

There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently.

CONCLUSIONS:

Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment.

KEYWORDS:

Electronic health records; Evaluation; Health information technology; Patient safety; Renal disease

PMID:
26087048
DOI:
10.1016/j.amjmed.2015.05.033
[Indexed for MEDLINE]
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