Utilization of computerized clinical decision support for potentially inappropriate medications

K Alagiakrishnan,1 M Ballermann,2 D Rolfson,1 K Mohindra,3 CA Sadowski,4 A Ausford,5 J Romney,6 RS Hayward71Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 2Chief Medical Information Office, Alberta Health Services, Division of Critical Care...

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Autores principales:	Alagiakrishnan K, Ballermann M, Rolfson D, Mohindra K, Sadowski CA, Ausford A, Romney J, Hayward RS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	polypharmacy Beers Criteria deprescribing best practice advisory alert fatigue e-prescribing prescribing Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/3043928686cc4240b4bec4c326a0ca7f
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spelling	oai:doaj.org-article:3043928686cc4240b4bec4c326a0ca7f2021-12-02T09:59:44ZUtilization of computerized clinical decision support for potentially inappropriate medications1178-1998https://doaj.org/article/3043928686cc4240b4bec4c326a0ca7f2019-04-01T00:00:00Zhttps://www.dovepress.com/utilization-of-computerized-clinical-decision-support-for-potentially--peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998K Alagiakrishnan,1 M Ballermann,2 D Rolfson,1 K Mohindra,3 CA Sadowski,4 A Ausford,5 J Romney,6 RS Hayward71Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 2Chief Medical Information Office, Alberta Health Services, Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; 3OpTime OR and Anesthesia, Connect Care, Information Systems, Alberta Health Services, Edmonton, Alberta, Canada; 4Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada; 5Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; 6Division of Endocrinology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 7Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaBackground: Electronic medical record (EMR) alerts may inform point of care decisions, including the decision to prescribe potentially inappropriate medications (PIM) identified in the Beers criteria. EMR alerts may not be considered relevant or informative in the clinician context, leading to a phenomenon colloquially known as “alert fatigue.”Objective: To assess the frequency of clinical interaction with EMR alerts and associated deprescribing behaviors in ambulatory settings.Methods: This is a retrospective observational study in two ambulatory clinics (the Kaye Edmonton Clinic Senior’s Clinic and the Lynnwood Family Practice Clinic) in Edmonton over an observational period of 30 months. Statistical analysis was done using descriptive statistics, chi-square and regression analysis.Results: The reminder performance for interactions with the alert was 17.2% across the two clinics. The Number Needed to Remind (NNR) or mean number of alerts shown on clinician screens prior to a single interaction of any kind with the alert was 5.8. When actions were defined as a deprescribing (ie discontinuation) event that was related to the alert and that particular interaction in the EMR, the reminder performance was 1.2%, for an NNR of 82.8.Conclusion: The configuration of alerts in the EMR was not associated with a clinically detectable increase in the uptake of the Beers criteria for high hazard medications.Keywords: polypharmacy, Beers Criteria, deprescribing, best practice advisory, alert fatigue, e-prescribing, prescribingAlagiakrishnan KBallermann MRolfson DMohindra KSadowski CAAusford ARomney JHayward RSDove Medical PressarticlepolypharmacyBeers Criteriadeprescribingbest practice advisoryalert fatiguee-prescribingprescribingGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 753-762 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	polypharmacy Beers Criteria deprescribing best practice advisory alert fatigue e-prescribing prescribing Geriatrics RC952-954.6
spellingShingle	polypharmacy Beers Criteria deprescribing best practice advisory alert fatigue e-prescribing prescribing Geriatrics RC952-954.6 Alagiakrishnan K Ballermann M Rolfson D Mohindra K Sadowski CA Ausford A Romney J Hayward RS Utilization of computerized clinical decision support for potentially inappropriate medications
description	K Alagiakrishnan,1 M Ballermann,2 D Rolfson,1 K Mohindra,3 CA Sadowski,4 A Ausford,5 J Romney,6 RS Hayward71Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 2Chief Medical Information Office, Alberta Health Services, Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; 3OpTime OR and Anesthesia, Connect Care, Information Systems, Alberta Health Services, Edmonton, Alberta, Canada; 4Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada; 5Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; 6Division of Endocrinology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; 7Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaBackground: Electronic medical record (EMR) alerts may inform point of care decisions, including the decision to prescribe potentially inappropriate medications (PIM) identified in the Beers criteria. EMR alerts may not be considered relevant or informative in the clinician context, leading to a phenomenon colloquially known as “alert fatigue.”Objective: To assess the frequency of clinical interaction with EMR alerts and associated deprescribing behaviors in ambulatory settings.Methods: This is a retrospective observational study in two ambulatory clinics (the Kaye Edmonton Clinic Senior’s Clinic and the Lynnwood Family Practice Clinic) in Edmonton over an observational period of 30 months. Statistical analysis was done using descriptive statistics, chi-square and regression analysis.Results: The reminder performance for interactions with the alert was 17.2% across the two clinics. The Number Needed to Remind (NNR) or mean number of alerts shown on clinician screens prior to a single interaction of any kind with the alert was 5.8. When actions were defined as a deprescribing (ie discontinuation) event that was related to the alert and that particular interaction in the EMR, the reminder performance was 1.2%, for an NNR of 82.8.Conclusion: The configuration of alerts in the EMR was not associated with a clinically detectable increase in the uptake of the Beers criteria for high hazard medications.Keywords: polypharmacy, Beers Criteria, deprescribing, best practice advisory, alert fatigue, e-prescribing, prescribing
format	article
author	Alagiakrishnan K Ballermann M Rolfson D Mohindra K Sadowski CA Ausford A Romney J Hayward RS
author_facet	Alagiakrishnan K Ballermann M Rolfson D Mohindra K Sadowski CA Ausford A Romney J Hayward RS
author_sort	Alagiakrishnan K
title	Utilization of computerized clinical decision support for potentially inappropriate medications
title_short	Utilization of computerized clinical decision support for potentially inappropriate medications
title_full	Utilization of computerized clinical decision support for potentially inappropriate medications
title_fullStr	Utilization of computerized clinical decision support for potentially inappropriate medications
title_full_unstemmed	Utilization of computerized clinical decision support for potentially inappropriate medications
title_sort	utilization of computerized clinical decision support for potentially inappropriate medications
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/3043928686cc4240b4bec4c326a0ca7f
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Utilization of computerized clinical decision support for potentially inappropriate medications

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