By Sarah Guy
Hospital physician prescribers frequently do not use shortcut functions in electronic prescribing (e-prescribing) systems, leading to inefficiency and revealing possible misalignment with users' prescribing behaviors, report Australian researchers.
Furthermore, of 2209 active orders studied over a 1-month period in one hospital, almost a third triggered at least one alert, most frequently telling the prescriber that the order duplicated an existing order.
The researchers found that if shortcut systems had been used properly in these cases, such as modifying an existing order rather than creating a new one, one-third of them would have been prevented.
"Designs which aim to improve the efficiency of the prescribing process but which do not align with the cognitive processes of users may fail to achieved this desired outcome and produce unexpected consequences such as triggering clinically unnecessary alerts and user frustration," say Melissa Baysari (St Vincent's Hospital, Darlinghurst, New South Wales) and co-investigators.
The team reviewed 180 patient medication charts that incorporated use of MedChart, an electronic medication management system.
In all, 27.2% of the mean 12.3 medication orders per patient triggered one or more computerized alerts, with the majority being duplication messages or local messages giving prescribers advice.
Almost half (40%) of the duplication alerts were caused by the ordering of a different drug in the same therapeutic class as a medication already prescribed and 82.2% of alerts arising from these scenarios were nonpreventable as both orders were "active." report the researchers in the Journal of the American Medical Informatics Association.
However, in the case of duplications where one of the orders had already elapsed, 56.1% of alerts would have been prevented if users had employed the "MODIFY" function of MedChart to alter the existing order, notes the team.
"By maintaining the 24 h time frame for certain medications only... (where a second dose within 24 h of a one daily dosing regimen would pose a significant risk of toxicity)... a large proportion of duplication alerts would be eliminated," remark Baysari et al.
The findings indicate a possible discordance between how prescribers undertake the ordering task, and how the task is reflected in the design of the system, they add.
"Developers of decision-support systems should test the extent to which technically preventable alerts may arise when prescribers fail to use system functions as designed," the authors conclude.
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