Optimizing drug-dose alerts using commercial software throughout an integrated health care system

Author:

Saiyed Salim M123,Greco Peter J456,Fernandes Glenn7,Kaelber David C45689

Affiliation:

1. Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA

2. Department of Family Medicine, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

3. CaroMont Health, Gastonia, NC, USA

4. Department of Information Services, the MetroHealth System, Case Western Reserve University, Cleveland, OH, USA

5. Department of Internal Medicine, the MetroHealth System, Case Western Reserve University

6. Department of Pediatrics, the MetroHealth System, Case Western Reserve University

7. Department of Pharmacy, the MetroHealth System, Case Western Reserve University

8. Department of Epidemiology and Biostatistics, the MetroHealth System, Case Western Reserve University,

9. Center for Clinical Informatics Research and Education, the MetroHealth System, Case Western Reserve University

Abstract

Abstract All default electronic health record and drug reference database vendor drug-dose alerting recommendations (single dose, daily dose, dose frequency, and dose duration) were silently turned on in inpatient, outpatient, and emergency department areas for pediatric-only and nonpediatric-only populations. Drug-dose alerts were evaluated during a 3-month period. Drug-dose alerts fired on 12% of orders (104 098/834 911). System-level and drug-specific strategies to decrease drug-dose alerts were analyzed. System-level strategies included: (1) turning off all minimum drug-dosing alerts, (2) turning off all incomplete information drug-dosing alerts, (3) increasing the maximum single-dose drug-dose alert threshold to 125%, (4) increasing the daily dose maximum drug-dose alert threshold to 125%, and (5) increasing the dose frequency drug-dose alert threshold to more than 2 doses per day above initial threshold. Drug-specific strategies included changing drug-specific maximum single and maximum daily drug-dose alerting parameters for the top 22 drug categories by alert frequency. System-level approaches decreased alerting to 5% (46 988/834 911) and drug-specific approaches decreased alerts to 3% (25 455/834 911). Drug-dose alerts varied between care settings and patient populations.

Publisher

Oxford University Press (OUP)

Subject

Health Informatics

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