RT Journal Article
SR Electronic
T1 The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour & improve safety
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP bmjqs-2020-012283
DO 10.1136/bmjqs-2020-012283
A1 Oliver Cerqueira
A1 Mohsain Gill
A1 Bishr Swar
A1 Katherine Ann Prentice
A1 Shannon Gwin
A1 Brent W Beasley
YR 2021
UL http://qualitysafety.bmj.com/content/early/2021/03/14/bmjqs-2020-012283.abstract
AB Background Prescribing alerts of an electronic health record are meant to be protective, but often are disruptive to providers. Our goal was to assess the effectiveness of interruptive medication-prescriber alerts in changing prescriber behaviour and improving patient outcomes in ambulatory care settings via computerised provider order entry (CPOE) systems.Methods A standardised search strategy was developed and applied to the following key bibliographical databases: PubMed, Embase, CINAHL and The Cochrane Library. Non-comparison studies and studies on non-interrupted alerts were eliminated. We developed a standardised data collection form and abstracted data that included setting, study design, category of intervention alert and outcomes measured. The search was completed in August 2018 and repeated in November of 2019 and of 2020 to identify any new publications during the time lapse.Results Ultimately, nine comparison studies of triggered alerts were identified. Each studied at least one outcome measure illustrating how the alert affected prescriber decision-making. Provider behaviour was influenced in the majority, with most noting a positive change. Alerts decreased pharmaceutical costs, moved medications toward preferred medications tiers and steered treatments toward evidence-based choices. They also decreased prescribing errors. Clinician feedback, rarely solicited, expressed frustration with alerts creating a time delay.Conclusion The current evidence shows a clear indication that many categories of alerts are effective in changing prescriber behaviour. However, it is unclear whether these behavioural changes lead to improved patient outcomes. Despite the rapid transition to CPOE use for patient care, there are few rigorous studies of triggered alerts and how workflow interruptions impact patient outcomes and provider acceptance.All data relevant to the study are included in the article or uploaded as supplemental information.