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safety alert

Indications: - component of computerized provider order entry - reduce medication errors - improve adherence to recommended treatments * yet to improve clinical outcomes Epidemiology: - ~60% of automated notifications of actionable tests pending at hospital discharge with documented follow-up in the medical record [5] Complications: - alert fatigue [1] - renal or age warnings often overlooked [1] - alerts rendered meaningless by their sheer number [2] - primary care physicians receive ~77 notifications daily [3] - VAMC providers receive > 100 electronic alerts/day, each requiring ~ 85 seconds to address (> 2 hours/day) [4] - electronic alerts to avoid cephalosporin use in patients with history of penicillin allergy reduces use of cephalosporins [6]

Related

electronic medical record (EMR); electronic health record (EHR)

References

  1. Nanji KC, Seger DL, Slight SP et al. J Am Med Inform Assoc. 2017 Oct 27; Medication-related clinical decision support alert overrides in inpatients. PMID: 29092059 https://psnet.ahrq.gov/resources/resource/31608
  2. Rosenbaum L Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine. N Engl J Med 2015; 373:1585-1588. October 22, 2015. PMID: 26488690 http://www.nejm.org/doi/full/10.1056/NEJMp1509961
  3. Murphy DR, Meyer AN, Russo E The Burden of Inbox Notifications in Commercial Electronic Health Records. JAMA Intern Med. 2016 Apr 1;176(4):559-60. PMID: 26974737
  4. Shah T, Patel-Teague S, Kroupa L, Meyer AND, Singh H. Impact of a national QI programme on reducing electronic health record notifications to clinicians. BMJ Qual Saf. 2018 Mar 5 PMID: 29507122 Free Article https://psnet.ahrq.gov/resources/resource/31968
  5. Dalal AK, Schaffer A, Gershanik EF, et al. The impact of automated notification on follow-up of actionable tests pending at discharge: a cluster-randomized controlled trial. J Gen Intern Med. 2018 Mar 12; PMID: 29532297 https://psnet.ahrq.gov/resources/resource/31998
  6. Macy E et al. Association between removal of a warning against cephalosporin use in patients with penicillin allergy and antibiotic prescribing. JAMA Netw Open 2021 Apr 1; 4:e218367. PMID: 33914051 PMCID: PMC8085727 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779305