Tiering Drug-Drug Interaction Alerts by Severity Increases Compliance Rates
Tiering Drug-Drug Interaction Alerts by Severity Increases Compliance Rates
复制标题
DOI：
10.1197/jamia.m2808
复制
发表时间：
2009-01-01
影响因子：
6.4
通讯作者：
Gandhi, Tejal K.
中科院分区：
文献类型：
--
作者：
Paterno, Marilyn D.;Maviclia, Saverio M.;Gandhi, Tejal K.
目的：几乎没有数据可以测量计算机化提供者订单输入系统（CPOE）中按严重程度（“分层”）区分药物相互作用（DDI）警报的效果。我们试图确定，如果供应商遵守DDI警报在住院设置的比率不同时，分层presentations.Design：我们进行了回顾性分析，从2/1/2004年至2/1/2005年期间在两个学术医疗中心住院患者的警报日志数据。两个住院患者CPOE系统均使用相同的DDI检查服务，但其中一个系统按严重程度显示不同的警报（分层显示，包括最严重警报的硬停止），而另一个系统则没有。参与者是生成DDI警报的成年住院患者和编写订单的提供者。警报在订单输入过程中，提供的机会，以改变病人的药物订单，以避免interaction.Measurements：率的遵守警报在分层网站相比，非分层site.Results：我们审查了71,350警报，其中39,474发生在非分层网站和31,876在分层网站。分层DDI警报的研究中心对DDI警报的依从性显著高于非分层研究中心（29% vs. 10%，p < 0.001）。在分层站点，100%的最严重警报被接受，而在非分层站点仅为34%;分层站点也更有可能接受中度严重警报（29% vs. 10%）。按严重程度分级的警报与住院患者DDI警报的更高依从率相关，而缺乏分层与更严重警报的高覆盖率相关。
Objective: Few data exist measuring the effect of differentiating drug-drug interaction (DDI) alerts in computerized provider order entry systems (CPOE) by level of severity ("tiering"). We sought to determine if rates of provider compliance with DDI alerts in the inpatient setting differed when a tiered presentation was implemented.Design: We performed a retrospective analysis of alert log data on hospitalized patients at two academic medical centers during the period from 2/1/2004 through 2/1/2005. Both inpatient CPOE systems used the same DDI checking service, but one displayed alerts differentially by severity level (tiered presentation, including hard stops for the most severe alerts) while the other did not. Participants were adult inpatients who generated a DDI alert, and providers who wrote the orders. Alerts were presented during the order entry process, providing the with the opportunity to change the patient's medication orders to avoid the interaction.Measurements: Rate of compliance to alerts at a tiered site compared to a non-tiered site.Results: We reviewed 71,350 alerts, of which 39,474 occurred at the non-tiered site and 31,876 at the tiered site. Compliance with DDI alerts was significantly higher at the site with tiered DDI alerts compared to the non-tiered site (29% vs. 10%, p < 0.001). At the tiered site, 100% of the most severe alerts were accepted, vs. only 34% at the non-tiered site; moderately severe alerts were also more likely to be accepted at the tiered site (29% vs. 10%).Conclusion: Tiered alerting by severity was associated with higher compliance rates of DDI alerts in the inpatient setting, and lack of tiering was associated with a high override rate of more severe alerts.