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Safety/Quality

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Clinicians value medication safety alerts and welcome small-group training to make better use of them

Busy clinicians generally find computerized safety alerts helpful for providing prescribing and preventive health information. However, the alerts need to be concise and relevant, have clear action steps, and provide options for users with different experience levels and work styles, according to a recent study. The study was supported by the Agency for Healthcare Research and Quality through the Centers for Education and Research on Therapeutics (CERTs) cooperative agreement (HS11843).

Members of the HMO Research Network CERT conducted interviews with 20 primary care providers at a large group-model HMO where prescribers have used computerized order entry since 1996. They asked clinicians about their emotional response to sample alerts, level of attention (ignore or read), perceived barriers to use, and usual clinical response.

More than half of those interviewed felt that it would be unwise to let clinicians control or avoid safety alerts. On the other hand, many interviewees said they were often frustrated due to delays caused by an alert, difficulty interpreting an alert, and receiving the same alert repeatedly. Alerts that intruded on their workflow were particularly annoying and subject to override. These included health maintenance alerts such as overdue tobacco cessation counseling or the need to schedule a screening exam, which popped up when they opened a patient's chart.

Clinicians considered alerts received during the medication prescribing process to be more helpful than alerts received at other times. They particularly welcomed alerts pertaining to agents with which they were less familiar, drug interactions, drugs to which the patient had an allergy, and appropriate dosing. They preferred alerts that were clearly written, provided options for alternative medications, or offered a single "button" solution to the clinical issue. Most preferred small-group educational sessions tied to existing meetings over E-mail for advance notice of new alerts, especially for new and complex areas, and preferred training by local physicians with clinical and electronic medical record expertise rather than outside experts.

See "How to design computerized alerts to ensure safe prescribing practices," by Adrianne Feldstein, M.D., M.S., Steven R. Simon, M.D., Jennifer Schneider, M.P.H., and others, in the November 2004 Joint Commission Journal on Quality and Safety 30(11), pp. 602-613.

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