TY - JOUR T1 - Interruptive alerts: only one part of the solution for clinical decision support JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 933 LP - 936 DO - 10.1136/bmjqs-2021-013391 VL - 30 IS - 12 AU - Yogini H Jani AU - Bryony Dean Franklin Y1 - 2021/12/01 UR - http://qualitysafety.bmj.com/content/30/12/933.abstract N2 - It is widely accepted that electronic health records, computerised provider order entry (CPOE) and electronic-prescribing systems represent a way forward for patient safety. Even relatively basic electronic-prescribing systems have been shown to improve patient safety by eliminating the ‘technical’ prescription writing errors of clarity and completion, such as those related to poor handwriting or missing information.1 2 However, reductions in errors relating to clinical decisions are likely to require more advanced systems incorporating clinical decision support systems (CDSS), which may also be linked to patient-specific information. A recent overview highlights that CDSS ‘…is comprised of software designed to be a direct aid to clinical-decision making, in which the characteristics of an individual patient are matched to a computerised clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician for a decision’.3 Within electronic-prescribing and CPOE systems, such recommendations are often presented to the user as interruptive pop-up alerts, including those relating to allergies, drug–drug interactions and potentially inappropriate doses.The systematic review by Cerqueira and colleagues4 in this issue of BMJ Quality & Safety focuses on the effectiveness of such interruptive alerts on prescribing behaviour in outpatient and ambulatory care settings. The review specifically excluded other types of CDSS as well as non-interruptive alerts. The authors identified only nine comparative studies of interruptive alerts that met their inclusion criteria, of which three were randomised controlled trials, with randomisation at either the level of the practice or the prescriber. Eight of the nine studies were from North America. The effectiveness of interruptive alerts on prescriber behaviour was conceptualised as prescriber acceptance of the alerts leading to changes in prescribing practices, medication costs and/or prescribing errors. The authors conclude that seven of the nine studies demonstrated significant provider behaviour … ER -