Home|Journals|Articles by Year|Audio Abstracts
 

Original Article



Medication Errors and Patient Safety: Evaluation of Physicians’ Responses to Medication-Related Alert Overrides in Clinical Decision Support Systems

Taghreed Justinia, Weam Qattan, Ahmed Almenhali, Abdulaziz Abo-Khatwa, Omar Alharbi, Talal Alharbi.




Abstract

Background: Clinical decision support systems (CDSS) can enhance patient safety and reduce medication errors by giving physicians alerts while dispensing medications. Physicians inappropriately override these alerts for various reasons, which can possibly lead to medication errors and impact patient safety. Objective: To assess the appropriateness of overridden major medication-related alerts, to investigate the reasons behind inappropriate overriding, and to evaluate if medication errors occur in inappropriately overridden alerts. Methods: A mixed-methods study. Quantitative: Retrospective observation to evaluate the appropriateness of major drug-dose related alert overrides. A simple random sample was taken from appropriate and inappropriate overrides and reviewed for medication errors. Qualitative: Semi-Structured Interviews were conducted with ten consultant physicians from various specialties. Interviews were transcribed and coded inductively then analyzed using Thematic Content Analysis. Results: Out of 1087 alert overrides that were evaluated for appropriateness, 738 were inappropriately overridden (67.89%). In a sample of 283 inappropriate and 92 appropriate overrides; the resulted medication errors were 7 and 0, respectively. Qualitative analysis resulted in three emergent themes; Judgement, Experience & Guidelines, CDSS Issues & Limitations, Physician Behavior & Safety. Conclusion: The majority of alerts were found to be inappropriately overridden. This can be attributed to physician reliance on their clinical knowledge and medication databases, having the pharmacists’ checks, and alert fatigue. CDSS alerts can be improved by making them more prominent and suppressing or descaling unnecessary alerts. The drop-down justification list can be enhanced by adding free text options and relating recommended dosing to disease or specialty.

Key words: CDSS, clinical decision support systems, alert override, medication error, medical error, alert fatigue, medication alert.






Full-text options


Share this Article


Online Article Submission
• ejmanager.com




ejPort - eJManager.com
Refer & Earn
JournalList
About BiblioMed
License Information
Terms & Conditions
Privacy Policy
Contact Us

The articles in Bibliomed are open access articles licensed under Creative Commons Attribution 4.0 International License (CC BY), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.