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Sundermann M, Clendon O, McNeill R, Doogue M, Chin PKL. Optimising interruptive clinical decision support alerts for antithrombotic duplicate prescribing in hospital. Int J Med Inform 2024; 186:105418. [PMID: 38518676 DOI: 10.1016/j.ijmedinf.2024.105418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/05/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Duplicate prescribing clinical decision support alerts can prevent important prescribing errors but are frequently the cause of much alert fatigue. Stat dose prescriptions are a known reason for overriding these alerts. This study aimed to evaluate the effect of excluding stat dose prescriptions from duplicate prescribing alerts for antithrombotic medicines on alert burden, prescriber adherence, and prescribing. MATERIALS AND METHODS A before (January 1st, 2017 to August 31st, 2022) and after (October 5th, 2022 to September 30th, 2023) study was undertaken of antithrombotic duplicate prescribing alerts and prescribing following a change in alert settings. Alert and prescribing data for antithrombotic medicines were joined, processed, and analysed to compare alert rates, adherence, and prescribing. Alert burden was assessed as alerts per 100 prescriptions. Adherence was measured at the point of the alert as whether the prescriber accepted the alert and following the alert as whether a relevant prescription was ceased within an hour. Co-prescribing of antithrombotic stat dose prescriptions was assessed pre- and post-alert reconfiguration. RESULTS Reconfiguration of the alerts reduced the alert rate by 29 % (p < 0.001). The proportion of alerts associated with cessation of antithrombotic duplication significantly increased (32.8 % to 44.5 %, p < 0.001). Adherence at the point of the alert increased 1.2 % (4.8 % to 6.0 %, p = 0.012) and 11.5 % (29.4 % to 40.9 %, p < 0.001) within one hour of the alert. When ceased after the alert over 80 % of duplicate prescriptions were ceased within 2 min of overriding. Antithrombotic stat dose co-prescribing was unchanged for 4 out of 5 antithrombotic duplication alert rules. CONCLUSION By reconfiguring our antithrombotic duplicate prescribing alerts, we reduced alert burden and increased alert adherence. Many prescribers ceased duplicate prescribing within 2 min of alert override highlighting the importance of incorporating post-alert measures in accurately determining prescriber alert adherence.
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Affiliation(s)
- Milan Sundermann
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Olivia Clendon
- Department of Clinical Pharmacology, Te Whatu Ora Health New Zealand - Waitaha Canterbury, New Zealand
| | - Richard McNeill
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Matthew Doogue
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Clinical Pharmacology, Te Whatu Ora Health New Zealand - Waitaha Canterbury, New Zealand
| | - Paul K L Chin
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Clinical Pharmacology, Te Whatu Ora Health New Zealand - Waitaha Canterbury, New Zealand.
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Dahmke H, Schelshorn J, Fiumefreddo R, Schuetz P, Salili AR, Cabrera-Diaz F, Meyer-Massetti C, Zaugg C. Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm. Drugs Real World Outcomes 2024; 11:125-135. [PMID: 38183571 DOI: 10.1007/s40801-023-00405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician. METHODS We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint. RESULTS Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases. CONCLUSION The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.
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Affiliation(s)
- Hendrike Dahmke
- Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland.
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
| | - Jana Schelshorn
- Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Rico Fiumefreddo
- Medical University Clinic, General Internal and Emergency Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Clinic, General Internal and Emergency Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | | | | | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital-University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
| | - Claudia Zaugg
- Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland
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Chien SC, Chang YH, Yen CM, Onthoni DD, Wu IC, Hsu CC, Chiou HY, Chung RH. Exploring concepts and trends in informal caregiver burden: systematic review using citation network and content analysis. Aging Clin Exp Res 2023; 35:2873-2885. [PMID: 37907665 DOI: 10.1007/s40520-023-02582-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND With the increase in the aging population, informal caregivers have become an essential pillar for the long-term care of older individuals. However, providing care can have a negative impact and increase the burden on caregivers, which is a cause for concern. OBJECTIVE This study aimed to comprehensively depict the concept of "informal caregiver burden" through bibliometric and content analyses. METHODS We searched the Web of Science (WoS) database to obtain bibliometric data and included only papers published between 2013 and 2022. We used content analysis to extract and identify the core concepts within the text systematically. RESULTS Altogether, 934 papers were included in the bibliometric analysis, from which we selected 19 highly impactful papers for content analysis. The results indicate that researchers have focused on exploring the factors that impact informal caregiver burden. Meanwhile, there has been a widespread discussion regarding the caregiver burden among those caring for recipients with specific illnesses, such as dementia, Alzheimer's disease, and cancer, as these illnesses can contribute to varying levels of burden on informal caregivers. In addition, questionnaires and interviews emerged as the predominant methods for data collection in the realm of informal caregiver research. Furthermore, we identified 26 distinct assessment tools specifically tailored for evaluating burden, such as caregiver strain index (CSI). CONCLUSION For future studies, we suggest considering the intersectionality of factors contributing to the burden on informal caregivers. This approach could enhance the well-being of both caregivers and older care recipients.
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Affiliation(s)
- Shuo-Chen Chien
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Yu-Hung Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Chia-Ming Yen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, 632, Taiwan
| | - Djeane Debora Onthoni
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, 632, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ren-Hua Chung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan.
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Wang M, Jia M, Wei Z, Wang W, Shang Y, Ji H. Construction and effectiveness evaluation of a knowledge-based infectious disease monitoring and decision support system. Sci Rep 2023; 13:13202. [PMID: 37580359 PMCID: PMC10425425 DOI: 10.1038/s41598-023-39931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
To improve the hospital's ability to proactively detect infectious diseases, a knowledge-based infectious disease monitoring and decision support system was established based on real medical records and knowledge rules. The effectiveness of the system was evaluated using interrupted time series analysis. In the system, a monitoring and alert rule library for infectious diseases was generated by combining infectious disease diagnosis guidelines with literature and a real medical record knowledge map. The system was integrated with the electronic medical record system, and doctors were provided with various types of real-time warning prompts when writing medical records. The effectiveness of the system's alerts was analyzed from the perspectives of false positive rates, rule accuracy, alert effectiveness, and missed case rates using interrupted time series analysis. Over a period of 12 months, the system analyzed 4,497,091 medical records, triggering a total of 12,027 monitoring alerts. Of these, 98.43% were clinically effective, while 1.56% were invalid alerts, mainly owing to the relatively rough rules generated by the guidelines leading to several false alarms. In addition, the effectiveness of the system's alerts, distribution of diagnosis times, and reporting efficiency of doctors were analyzed. 89.26% of infectious disease cases could be confirmed and reported by doctors within 5 min of receiving the alert, and 77.6% of doctors could complete the filling of 33 items of information within 2 min, which is a reduction in time compared to the past. The timely reminders from the system reduced the rate of missed cases by doctors; the analysis using interrupted time series method showed an average reduction of 4.4037% in the missed-case rate. This study proposed a knowledge-based infectious disease decision support system based on real medical records and knowledge rules, and its effectiveness was verified. The system improved the management of infectious diseases, increased the reliability of decision-making, and reduced the rate of underreporting.
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Affiliation(s)
- Mengying Wang
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
| | - Mo Jia
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
| | - Zhenhao Wei
- Goodwill Hessian Health Technology Co. Ltd, Beijing, China
| | - Wei Wang
- Goodwill Hessian Health Technology Co. Ltd, Beijing, China
| | - Yafei Shang
- Goodwill Hessian Health Technology Co. Ltd, Beijing, China
| | - Hong Ji
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China.
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Gosselin L, Leguillon R, Rollin L, Lejeune E, Darmoni SJ, Grosjean J. Trends in computerized provider order entry: 20-year bibliometric overview. Front Digit Health 2023; 5:1217694. [PMID: 37497185 PMCID: PMC10367087 DOI: 10.3389/fdgth.2023.1217694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Background Drug-related problems (DRPs) can lead to serious health issues and have significant economic impacts on healthcare systems. One solution to address this issue is the use of computerized physician order entry systems (CPOE), which can help prevent DRPs by reducing the risk of medication errors. Objective The purpose of this study is to provide an analysis on scientific production of the past 20 years in order to describe trends in academic publishing on CPOE and to identify the major topics as well as the predominant actors (journals, countries) involved in this field. Methods A PubMed search was carried out to extract articles related to computerized provider order entry during the period January 1st 2003- December 31st 2022 using a specific query. Data were downloaded from PubMed in Extensible Markup Language (XML) and were processed through a dedicated parser. Results A total of 2,946 articles were retrieved among 623 journals. One third of these articles were published in eight journals. Publications grew strongly from 2002 to 2006, with a dip in 2008 followed by an increase again in 2009. After 2009, there follows a decreasing until 2022.The most producing countries are the USA with 51.39% of the publication over the period by France (3.80%), and Canada (3.77%). About disciplines, the top 3 is: "medical informatics" (21.62% of articles), "pharmacy" (19.04%), and "pediatrics" (6.56%). Discussion This study provides an overview of publication trends related to CPOE, which exhibited a significant increase in the first decade of the 21st century followed by a decline after 2009. Possible reasons for this decline include the emergence of digital health tools beyond CPOE, as well as healthcare professionals experiencing alert fatigue of the current system. Conclusion Future research should focus on analyzing publication trends in the field of medical informatics and decision-making tools to identify other areas of interest that may have surpassed the development of CPOE.
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Affiliation(s)
- Laura Gosselin
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Romain Leguillon
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Department of Pharmacy, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Laetitia Rollin
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
- Institute of Occupational Medicine, Rouen University Hospital, Rouen, France
| | - Emeline Lejeune
- Department of Digital Health, Rouen University Hospital, Rouen, France
| | - Stéfan J. Darmoni
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Julien Grosjean
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
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Dahmke H, Fiumefreddo R, Schuetz P, De Iaco R, Zaugg C. Tackling alert fatigue with a semi-automated clinical decision support system: quantitative evaluation and end-user survey. Swiss Med Wkly 2023; 153:40082. [PMID: 37454289 DOI: 10.57187/smw.2023.40082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
STUDY AIMS Clinical decision support systems (CDSS) embedded in hospital electronic health records efficiently reduce medication errors, but there is a risk of low physician adherence due to alert fatigue. At the Cantonal Hospital Aarau, a CDSS is being developed that allows the highly accurate detection and correction of medication errors. The semi-automated CDSS sends its alerts either directly to the physician or to a clinical pharmacist for review first. Our aim was to evaluate the performance of the recently implemented CDSS in terms of acceptance rate and alert burden, as well as physicians' satisfaction with the CDSS. METHODS All alerts generated by the clinical decision support systems between January and December 2021 were included in a retrospective quantitative evaluation. A team of clinical pharmacists performed a follow-up to determine whether the recommendation made by the CDSS was implemented by the physician. The acceptance rate was calculated including all alerts for which it was possible to determine an outcome. A web-based survey was conducted amongst physicians to assess their attitude towards the CDSS. The survey questions included overall satisfaction, helpfulness of individual algorithms, and perceived alert burden. RESULTS In 2021, a total of 10,556 alerts were generated, of which 619 triggered a direct notification to the physician and 2,231 notifications were send to the physician after evaluation by a clinical pharmacist. The acceptance rates were 89.8% and 68.4%, respectively, which translates as an overall acceptance rate of 72.4%. On average, clinical pharmacists received 17.2 alerts per day, while all of the hospital physicians together received 7.8 notifications per day. In the survey, 94.5% of physicians reported being satisfied or very satisfied with the CDSS. Algorithms addressing potential medication errors concerning anticoagulants received the highest usefulness ratings. CONCLUSION The development of this semi-automated clinical decision support system with context-based algorithms resulted in alerts with a high acceptance rate. Involving clinical pharmacists proved a promising approach to limit the alert burden of physicians and thus tackle alert fatigue. The CDSS is well accepted by our physicians.
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Affiliation(s)
- Hendrike Dahmke
- Hospital Pharmacy, Kantonsspital Aarau, Aarau, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Rico Fiumefreddo
- Department of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Department of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Claudia Zaugg
- Hospital Pharmacy, Kantonsspital Aarau, Aarau, Switzerland
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