April 20, 2014
Adding intuitive medication alerts to electronic medical records (EMRs) significantly reduces prescribing errors, according to a recent study.
Researchers redesigned drug-related warnings in an EMR system used by more than 150 Veterans Affairs medical centers for a simulation that tested the prescribing performances of 14 physicians, 2 nurse practitioners, and 4 clinical pharmacists. The simulation involved alerts that were both familiar and unfamiliar to the prescribers: 5 related to drug allergies, 11 that touched on drug interactions, and 3 involved drug–disease alerts.
According to the study, redesigned alerts significantly reduced median prescription errors from 4 to 2 out of a possible 11 mistakes. Prescribing accuracy improved because of human factor principles included in the revamped alerts, noted the researchers.
For example, the new design did away with scrolling through screens to see alerts, which eliminated warnings hidden below the visual field. Additionally, alerts that appeared during medication cancelations and repeatedly during the ordering process were eliminated to avoid confusion and alert fatigue.
The researchers noticed that presenting the information contained in alerts in tabular form reduced cognitive effort, helped maintain prescribers’ focus, and aided their search for information, which are keys to alarm effectiveness. The redesigned alerts also presented more useful information closer to the point-of-decision, including details of patients’ adverse reactions to drugs and specific medications to avoid.
Most of the prescribers were generally able to respond to the redesigned alerts without training or guidance, noted the researchers. They also completed prescriptions and worked through the new alerts quicker, and reported being more satisfied with the redesigned system.
“This study demonstrates that principles from other industries can be applied to the design of medication alerts to save time and improve safety,” said study lead author Dr. Alissa Russ, Richard Roudebush Veterans Affairs Medical Center research scientist, a Regenstrief Institute investigator and an adjunct assistant professor with the Purdue College of Pharmacy. “Many of the principles used in this study are broadly applicable.”
For example, Dr. Russ said pharmacists could use the study’s findings if they’re involved in discussions about redesigning medication alerts, order sets, or medication labels at their facilities.
She pointed out that the redesigned alerts lowered error rates, but errors still occurred, and emphasized that serious gaps remain in understanding how to effectively display medication alert information to prescribers.
“So our next step, which we have already begun, is to learn more about the decision-making process that providers go through when they encounter medication alerts," she added. "An improved understanding of this process will enable us to design even better alerts, with the ultimate goal of enhancing patient safety."
The study was published in the Journal of the American Medical Informatics Association.
1. Russ AL, Zillich AJ, Melton BL, et al. Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation. J Am Med Inform Assoc. 2014 Mar 25. [Epub ahead of print]