Compliance is low for computer alerts recommending conversion from intravenous to oral medications
Research Activities, January 2011, No. 365
As a way to cut costs and improve patient safety, hospitals try to substitute an oral therapy for an intravenous (IV) medication whenever possible. With the use of computerized physician order entry, physicians can now be alerted when such a substitution is feasible. A new study found, however, that physicians at a medical center did not always comply with these computer alerts. In addition, the rate of compliance was affected by patient location, type of personnel, and even the medication itself. The setting for the study was a 450-bed academic urban tertiary hospital where real-time alerts were used to recommend oral formulations for patients on IV medications. Twelve IV medications were selected where oral substitutes were available and clinically appropriate. In some cases, the oral substitute was not the same medication.
Researchers retrospectively analyzed electronic medical record data to determine the rate of physicians' compliance with IV-to-oral medication alerts. During a 15-month period, there were 3,919 computer alerts. The overall compliance rate was 18.7 percent. Nearly half of all alerts (46 percent) were handled by house staff. Their compliance rate was 19 percent, which was significantly higher than that of pharmacists (10 percent). Nurses demonstrated a high compliance rate of 36 percent, even though they only received 8 percent of the alerts. Among the 12 IV medications replaced, compliance rates were highest for rifampin (33.3 percent), famotidine (31.9 percent), and metronidazole (26.0 percent). Methylprednisolone had the lowest compliance rate (8.5 percent) among all 12 medications.
Hospital departments with the highest compliance rates were the pediatric intensive care unit (ICU), step-down unit, emergency department, and medical-surgical unit. Reasons given by physicians for overriding alerts included cancellation of oral diet, nausea and vomiting, and disease worsening that required the IV route of administration. Suspending alerts in ICU patients (where oral status changes frequently) and delaying alerts for a specific period of time may help improve alert compliance, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16973).
See "Analysis of computer alerts suggesting oral medication use during computerized order entry of I.V. medications," by William Galanter, M.D., Ph.D., Xiaoqing (Frank) Liu, Ph.D., and Bruce L. Lambert, Ph.D., in the July 1, 2010, American Journal of Health Systems Pharmacy 67, pp. 1101-1105.