gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Physicians' attitudes towards drug safety alerts in CPOE systems – A European survey

Meeting Abstract

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  • Martin Jung - UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol
  • Werner Oskar Hackl - UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol
  • Daniel Riedmann - UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol
  • Elske Ammenwerth - UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds407

DOI: 10.3205/11gmds407, URN: urn:nbn:de:0183-11gmds4070

Veröffentlicht: 20. September 2011

© 2011 Jung et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Electronic prescribing has the potential to reduce the number of adverse drug events (ADEs) in hospitals [1]. However, emotional aspects, like the physicians' adoption of computerized physician order entry systems (CPOE), have to be considered, otherwise, increased error rates and other 'unintended adverse consequences' (UACs) might occur [2]. Several CPOE design aspects, like the issue of alerting, have an influence on the physicians' attitudes [3]. The burden of high numbers of alerts for the prescribers is a fact that is commonly described in literature [4], [5], [6], [7]. Alert overload must not be underestimated, otherwise it may cause clinicians to override and ignore even important alerts, endangering patient safety [8], [9]. Several studies have provided insight into the attitudes of prescribers towards drug safety alerts in CPOE systems [10], [11], [12]. So far, however, it is not known whether and to which degree these attitudes depend on the level of computerized decision support (CDS) in the CPOE systems. Study questions: What is the attitude of physicians towards CDS in CPOE systems? How does it correlate with the level of CDS?

Methods: We performed a physician survey in six European hospitals. The hospitals comprised different levels of CDS within their CPOE systems, which we classified adopting Kuperman’s classification [13]. Paper questionnaires were distributed in four hospitals and electronic questionnaires were distributed in two hospitals. The questionnaire comprised 15 statements which were adopted from existing studies [10], [11], [12]. All items were scaled with a 4-point Likert scale. The data was analyzed with descriptive statistics and Kruskal-Wallis tests.

Results: The data acquisition has been completed in four hospitals. The response rate was between 9% and 53%. Prescribers who were using CPOE with CDS reported over-alerting in their facilities (54-62% agreement), but nonetheless seem to believe in the error-reducing capacities of CDS (73-91% agreement). All physicians do not want to be patronized by technology and prefer a focus on the most important alerts (83-96% agreement). The results did not generally diverge according to the level of CDS, but differences could be spotted between single hospitals.

Discussion and conclusion: All results have to be looked at carefully and generalizations cannot be made. However, this first approach to measuring the influence of various CDS levels on the physicians’ attitudes allows a deeper insight into the matter. The results from the study are exploited in the PSIP-project of the European Union (Patient Safety through Intelligent Procedures in medication, grant agreement n° 216130) [14].


References

1.
Ammenwerth E, Schnell-Inderst P, Machan C, et al. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc. 2008;15(5):585-600.
2.
Campbell EM, Sittig DF, Ash JS, et al. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13(5):547-56.
3.
Khajouei R, Jaspers MW. The impact of CPOE medication systems' design aspects on usability, workflow and medication orders: a systematic review. Methods Inf Med. 2010;49(1):3-19.
4.
Glassman PA, Simon B, Belperio P, et al. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40(12):1161-71.
5.
Peterson JF, Bates DW. Preventable medication errors: identifying and eliminating serious drug interactions. J Am Pharm Assoc (Wash). 2001;41(2):159-60.
6.
Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163(12):1409-16.
7.
Shane R. Computerized physician order entry: challenges and opportunities. Am J Health Syst Pharm. 2002;59(3):286-8.
8.
van der Sijs H, Aarts J, Vulto A, et al. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138-47.
9.
Shah NR, Seger AC, Seger DL, et al. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. 2006;13(1):5-11.
10.
Hor CP, O'Donnell JM, Murphy AW, et al. General practitioners' attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of Ireland: a cross sectional study. BMC Med Inform Decis Mak. 2010;10:2.
11.
Ko Y, Abarca J, Malone DC, et al. Practitioners' views on computerized drug-drug interaction alerts in the VA system. J Am Med Inform Assoc. 2007;14(1):56-64.
12.
Magnus D, Rodgers S, Avery AJ. GPs' views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther. 2002;27(5):377-82.
13.
Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2007;14(1):29-40.
14.
PSIP. PSIP – Patient Safety through Intelligent Procedures in medication [homepage on the Internet], Europe: PSIP consortium [updated 2011 Apr 5; cited 2010 Apr 13]. Available from: http://www.psip-project.eu/ Externer Link