Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial. Strom, B. L, Schinnar, R., Aberra, F., Bilker, W., Hennessy, S., Leonard, C. E, & Pifer, E. Archives of internal medicine, 170(17):1578–1583, September, 2010. doi abstract bibtex BACKGROUND: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts. METHODS: To evaluate the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007. RESULTS: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2% (111 of 194 hard stop alerts) in the intervention group and 13.5% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients. CONCLUSIONS: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00870298.
@article{strom_unintended_2010,
title = {Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial},
volume = {170},
issn = {1538-3679},
shorttitle = {Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction},
doi = {10.1001/archinternmed.2010.324},
abstract = {BACKGROUND: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts.
METHODS: To evaluate the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007.
RESULTS: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2\% (111 of 194 hard stop alerts) in the intervention group and 13.5\% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95\% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients.
CONCLUSIONS: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00870298.},
language = {eng},
number = {17},
journal = {Archives of internal medicine},
author = {Strom, Brian L and Schinnar, Rita and Aberra, Faten and Bilker, Warren and Hennessy, Sean and Leonard, Charles E and Pifer, Eric},
month = sep,
year = {2010},
pmid = {20876410},
keywords = {Anti-Infective Agents, Anticoagulants, Decision Making, Computer-Assisted, Decision Support Systems, Clinical, Drug Interactions, Drug Prescriptions, Drug Therapy, Computer-Assisted, Electronic prescribing, Hemorrhage, Humans, Medical Order Entry Systems, Medication Errors, Medication Systems, Hospital, Odds Ratio, Philadelphia, Reminder Systems, Time Factors, Trimethoprim-Sulfamethoxazole Combination, Warfarin},
pages = {1578--1583}
}
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E","Pifer, E."],"year":2010,"bibtype":"article","biburl":"https://bibbase.org/zotero/emmanuel.chazard","bibdata":{"bibtype":"article","type":"article","title":"Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial","volume":"170","issn":"1538-3679","shorttitle":"Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction","doi":"10.1001/archinternmed.2010.324","abstract":"BACKGROUND: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts. METHODS: To evaluate the effectiveness of a nearly \"hard stop\" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007. RESULTS: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2% (111 of 194 hard stop alerts) in the intervention group and 13.5% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients. CONCLUSIONS: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00870298.","language":"eng","number":"17","journal":"Archives of internal medicine","author":[{"propositions":[],"lastnames":["Strom"],"firstnames":["Brian","L"],"suffixes":[]},{"propositions":[],"lastnames":["Schinnar"],"firstnames":["Rita"],"suffixes":[]},{"propositions":[],"lastnames":["Aberra"],"firstnames":["Faten"],"suffixes":[]},{"propositions":[],"lastnames":["Bilker"],"firstnames":["Warren"],"suffixes":[]},{"propositions":[],"lastnames":["Hennessy"],"firstnames":["Sean"],"suffixes":[]},{"propositions":[],"lastnames":["Leonard"],"firstnames":["Charles","E"],"suffixes":[]},{"propositions":[],"lastnames":["Pifer"],"firstnames":["Eric"],"suffixes":[]}],"month":"September","year":"2010","pmid":"20876410","keywords":"Anti-Infective Agents, Anticoagulants, Decision Making, Computer-Assisted, Decision Support Systems, Clinical, Drug Interactions, Drug Prescriptions, Drug Therapy, Computer-Assisted, Electronic prescribing, Hemorrhage, Humans, Medical Order Entry Systems, Medication Errors, Medication Systems, Hospital, Odds Ratio, Philadelphia, Reminder Systems, Time Factors, Trimethoprim-Sulfamethoxazole Combination, Warfarin","pages":"1578–1583","bibtex":"@article{strom_unintended_2010,\n\ttitle = {Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial},\n\tvolume = {170},\n\tissn = {1538-3679},\n\tshorttitle = {Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction},\n\tdoi = {10.1001/archinternmed.2010.324},\n\tabstract = {BACKGROUND: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts.\nMETHODS: To evaluate the effectiveness of a nearly \"hard stop\" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007.\nRESULTS: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2\\% (111 of 194 hard stop alerts) in the intervention group and 13.5\\% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95\\% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients.\nCONCLUSIONS: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. 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