Human Factors Considerations for Contraindication Alerts

Alert fatigue is a ubiquitous problem in clinical decision support systems. Several remedies to alert fatigue have been proposed including improving the specificity of alerts and compliance with human factors principles. Human factors principles that are relevant for drug safety alerting have been identified and operationalized for drug-drug interactions (DDIs), resulting in a previously developed and validated quantitative instrument. Such an instrument is lacking for contraindications. This study describes the operationalization of human factors principles for contraindication alerting. Thirty items associated with 10 human factors principles are included in the instrument: 4 items are new, 5 are similar, and 21 are equal to the DDI-instrument. The instrument was further operationalized to a test protocol. Three independent persons used the test protocol. Inter-rater reliability indicated moderate agreem (kappa=0.540). It is feasible to test the implementation of human factors in contraindication alert design with the newly developed instrument.