Reducing Prescribing Errors Through Creatinine Clearance Alert Redesign
Reducing Prescribing Errors Through Creatinine Clearance Alert Redesign
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DOI：
10.1016/j.amjmed.2015.05.033
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发表时间：
2015-10-01
影响因子：
5.9
通讯作者：
Russ, Alissa L.
中科院分区：
文献类型：
--
作者：
Melton, Brittany L.;Zillich, Alan J.;Russ, Alissa L.
背景：文献显示电脑化肌酐清除率警报可减少处方中的错误，应用人为因素原则可进一步减少错误。我们的目标是将人为因素原则应用于肌酐清除率警报设计，并评估与原始警报相比，重新设计的警报是否提高了可用性并减少了处方错误。方法：20名退伍军人事务部（VA）门诊服务提供者（14名医生、2名执业护士和4名临床药师）在一项平衡研究中完成了2个可用性会话，以评估原始和重新设计的警报。每个环节都包括虚构的患者场景，其中有3种药物由于肾脏损害而需要改变处方，每种药物都与肌酐清除警报相关。收集定量和定性数据来评估警报可用性和处方错误的发生。结果：与原始警报相比，重新设计的警报减少了43%的处方错误（P = .001）。与原始警报相比，重新设计的警报显著减少了别嘌呤醇和布洛芬的处方错误率（分别为85%对40%和65%对25%，P = 0.012和P = 0.008），但螺内酯的处方错误率没有显著降低（85%对65%）。九家供应商（45%）表示，当他们遇到最初的警报设计时，他们对为什么会出现警报感到困惑。当实验室链接出现在重新设计的警报上时，实验室信息的访问频率增加了3.5倍。结论：虽然两种警报设计的处方错误率都很高，但重新设计的警报显著改善了处方结果。这项调查提供了一些关于如何设计警报以支持对肾功能损害患者更安全的处方的初步证据。(C) 2015爱思唯尔公司版权所有。
BACKGROUND: Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts.METHODS: Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors.RESULTS: There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently.CONCLUSIONS: Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment. (C) 2015 Elsevier Inc. All rights reserved.