Electronic prescription: Information improvements

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Ezine

  • Published: Apr 15, 2014
  • Author: David Bradley
  • Channels: Chemometrics & Informatics
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Veteran medication

Safer prescribing of medications could be possible thanks to a better approach for designing medication alerts that are presented in electronic medical records. The new approach, described online in the Journal of the American Medical Informatics Association also increased efficiency and reduced workload for health care providers.

Safer prescribing of medications could be possible thanks to a better approach for designing medication alerts that are presented in electronic medical records. The new approach, described online in the Journal of the American Medical Informatics Association also increased efficiency and reduced workload for health care providers.

"The VA [Veterans Affairs] electronic medical record system is one of the most widely used and respected EMR [electronic medical records] systems in the [USA]," explains human factors engineer Alissa Russ, a Research Scientist with the Department of Veterans Affairs, Regenstrief Institute and Purdue University College of Pharmacy in Indiana.

This EMR is used by providers at over 150 VA hospitals. We are looking at ways to improve the alert system for these providers and for patient care," explains Russ, who leads the research supported by a VA Health Services Research and Development grant.

Drug delivery

Russ and colleagues Alan Zillich, Brittany Melton (University of Kansas), Scott Russell, Siying Chen, Jeffrey Spina, Michael Weiner, Elizabette Johnson, Joanne Daggy, Sue McManus, Jason Hawsey, Anthony Puleo, Bradley Doebbeling and Jason Saleem carried out a simulation study in which they drew on knowledge from other industries and applications, such as the design of road signs and medication warning labels, to redesign medication alerts, including drug allergy and drug-drug interaction warnings. They incorporated several changes to make the language more concise and provide a table-like format to help providers scan for information quickly.

Some of the redesigned alerts also presented more detail, such as a patient’s previous symptoms and medical laboratory tests results, so that providers did not have to search for this information elsewhere in the patient's electronic medical record. In addition to adopting safer prescribing practices, the doctors, nurse practitioners and clinical pharmacists in the study were happier with the redesigned display and quality of the information presented. These types of design changes can help providers pay attention to alerts and may reduce some aspects of alert fatigue, according to Russ.

Human factors

The investigators used methods associated with the field of human factors engineering to study the alerts and found that healthcare workers who participated in the simulation were occasionally cancelling medications inadvertently when they had thought that they were placing an order for the medication. Conversely, they also unintentionally ordered some medications due to confusion caused by the old alert design. These findings have not previously been reported for medication alerts and the simulation used a group of entirely fictitious patients, so that alert designs could be assessed without putting anyone at risk.

The study's authors suggest that improving medication alert design could reduce the number of errors considerably, by reducing the potential for confusion among busy healthcare workers. who are often working under stressful situations. They also found that repeating alerts in the same ordering session for a given patient did not substantially reduce prescribing errors.

"Serious gaps remain in understanding how to effectively display medication alert information to prescribers. In our study, prescribing errors significantly declined with the redesign, but the number of these errors remains too high. So our next step, which we have already begun, is to learn more about the decision-making process that providers go through when they encounter medication alerts," Russ adds. "An improved understanding of this process will enable us to design even better alerts, with the end goal of enhancing patient safety."

Related Links

J Am Med Inform Assoc, 2014, online: "Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation"

Article by David Bradley

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

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