Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction A Randomized Controlled Trial

被引:147
作者
Strom, Brian L. [1 ,2 ]
Schinnar, Rita [1 ,2 ]
Aberra, Faten [3 ]
Bilker, Warren [1 ,2 ]
Hennessy, Sean [1 ,2 ]
Leonard, Charles E. [1 ,2 ]
Pifer, Eric [1 ,2 ]
机构
[1] Univ Penn, Sch Med, Ctr Clin Epidemiol & Biostat, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
[2] Univ Penn, Sch Med, Ctr Educ & Res Therapeut, Philadelphia, PA 19104 USA
[3] Univ Penn, Sch Med, Div Gastroenterol, Philadelphia, PA 19104 USA
基金
美国医疗保健研究与质量局;
关键词
DECISION-SUPPORT; PRIMARY-CARE; HOSPITALIZED-PATIENTS; MEDICATION ERRORS; WARFARIN; RISK; CONSEQUENCES; PRESCRIBERS; REASONS; SYSTEMS;
D O I
10.1001/archinternmed.2010.324
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts. Methods: To evaluate the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007. Results: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2% (111 of 194 hard stop alerts) in the intervention group and 13.5% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients. Conclusions: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits.
引用
收藏
页码:1578 / 1583
页数:6
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