Event Analysis for Automated Estimation of Absent and Persistent Medication Alerts: Novel Methodology.

Background: Event analysis is a promising approach to estimate the acceptance of medication alerts issued by computerized physician order entry (CPOE) systems with an integrated clinical decision support system (CDSS), particularly when alerts cannot be interactively confirmed in the CPOE-CDSS due to its system architecture. Medication documentation is then reviewed for documented evidence of alert acceptance, which can be a time-consuming process, especially when performed manually. Objective: We present a new automated event analysis approach, which was applied to a large data set generated in a CPOE-CDSS with passive, noninterruptive alerts. Methods: Medication and alert data generated over 3.5 months within the CPOE-CDSS at Heidelberg University Hospital were divided into 24-hour time intervals in which the alert display was correlated with associated prescription changes. Alerts were considered "persistent" if they were displayed in every consecutive 24-hour time interval due to a respective active prescription until patient discharge and were considered "absent" if they were no longer displayed during continuous prescriptions in the subsequent interval. Results: Overall, 1670 patient cases with 11,428 alerts were analyzed. Alerts were displayed for a median of 3 (IQR 1-7) consecutive 24-hour time intervals, with the shortest alerts displayed for drug-allergy interactions and the longest alerts displayed for potentially inappropriate medication for the elderly (PIM). Among the total 11,428 alerts, 56.1% (n=6413) became absent, most commonly among alerts for drug-drug interactions (1915/2366, 80.9%) and least commonly among PIM alerts (199/499, 39.9%). Conclusions: This new approach to estimate alert acceptance based on event analysis can be flexibly adapted to the automated evaluation of passive, noninterruptive alerts. This enables large data sets of longitudinal patient cases to be processed, allows for the derivation of the ratios of persistent and absent alerts, and facilitates the comparison and prospective monitoring of these alerts.

Impacto de la dispensación automatizada de medicamentos en la seguridad del paciente. Evidencia de una Unidad de Cuidado Crítico en Colombia

Objetivo: Determinar el impacto de la dispensación automatizada en la seguridad del paciente en una unidad de cuidado crítico y medir el tiempo de dispensación para conocer los efectos en la atención del paciente y los trabajadores de la salud. Metodología: Estudio retrospectivo observacional. La técnica fue documentar la dispensación tomando las bases de datos en el sistema tradicional y automatizado procesados en Microsoft Excel y medición del tiempo. Resultados: Con el sistema automatizado el uso de controles para el acceso en la dispensación de los medicamentos e insumos fue del 100 %. Y, el porcentaje de casos de problemas con el uso de medicamentos en el sistema tradicional fue de 0,38 y en el automatizado descendió a 0,007. Discusión: Pasar de manual a automatizado en la dispensación representa reducción del tiempo de un día a 22 segundos, el uso del 100 % de las alertas tecnológicas y la eficiencia en los procesos de dispensación reflejado por el 15,2 % de transacciones en el cargue de los dispositivos médicos y medicamentos. Conclusiones: La dispensación automatizada impacta en el paciente acortando el tiempo para que el medicamento sea administrado oportunamente, en los trabajadores este tiempo es una ventaja para invertir en los cuidados, el equipo de sistema automatizado adiciona controles que ayudan al doble chequeo en el alistamiento y cargue y la reducción de eventos adversos. Y, en la organización disminuye los eventos relacionados con roturas de envases, daño de empaques por la menor manipulación y disposición de medicamentos en gabinetes cerrados.

SUMMARY Objective: To determine the impact of automated dispensing on patient safety in a Critical Care Unit and measure the dispensing time to know the effects on patient care and health workers. Methodology: Retrospective observational study. The technique was to document the dispensing taking the databases in the traditional and automated system processed in Microsoft Excel and measuring time. Results: With the automated system, the use of controls for access in the dispensing of medicines and supplies was 100 %. And, the percentage of cases of problems with the use of medicines in the traditional system was 0.38 and in the automated system it fell to 0.007. Discussion: Going from manual to automated in the dispensing represents a reduction in time from one day to 22 seconds, the use of 100 % of technological alerts and the efficiency in the dispensing processes reflected by 15.2 % of transactions in the load of medical devices and drugs. Conclusions: Automated dispensing impacts on the patient by shortening the time for the medication to be administered in a timely manner, in workers this time is an advantage to invest in care, the automated system equipment adds controls that help the double check in the readiness and burden and reducing adverse events. And, in the organization it reduces the events related to container breakage, packaging damage due to less manipulation and disposal of medicines in closed cabinets.

Objetivo: Determinar o impacto da dispensação automatizada na segurança do paciente em um unidade de terapia intensiva e medir o tempo de dispensação para conhecer os efeitos no paciente cuidadores e trabalhadores da saúde. Metodologia: Estudo observacional retrospectivo. O técnica foi documentar a dispensação tomando os bancos de dados na forma tradicional e sistema automatizado processado em Microsoft Excel e medição de tempo. Resultados: Com o sistema automatizado, o uso de controles para acesso na dispensação de medicamentos e suprimentos foi de 100%. E, a porcentagem de casos de problemas com o uso de medicamentos no sistema tradicional foi de 0,38 e no sistema automatizado caiu para 0,007. Discussão : Passar de manual para automatizado na dispensação representa redução do tempo de um dia para 22 segundos, o uso de 100% de tecnologia alertas e a eficiência nos processos de dispensação refletida em 15,2% das transações na carga de dispositivos médicos e medicamentos. Conclusões: dispensação automatizada impactos no paciente, diminuindo o tempo para a medicação ser administrada em tempo hábil, nos trabalhadores este tempo é uma vantagem para investir no atendimento, a automatização equipamentos do sistema adicionam controles que auxiliam na dupla verificação da prontidão e sobrecarga e redução de eventos adversos. E, na organização, reduz o eventos relacionados à quebra de contêineres, danos à embalagem devido à menor manipulação e descarte de medicamentos em armários fechados.

Adoption of medication alert systems in hospital outpatient departments in Taiwan.

OBJECTIVE: The adoption of medication alert systems in the health care sector varies among regions. In Taiwan, the health authority introduced policies in 2005 to encourage the adoption of medication alert systems in hospitals. This study aimed to understand the adoption of medication alert systems in the outpatient departments of hospitals in Taiwan using a nationwide survey. METHODS: A questionnaire was developed and mailed to 380 accredited general hospitals in Taiwan in 2013. The information collected from the questionnaire concerning the outpatient department included (1) the time of adoption of a medication alert system; (2) the operation of individual alert functions: availability, management, and stability; and (3) hospital characteristics: accreditation level, teaching status, ownership, and number of beds. RESULTS: A total of 216 hospitals completed and returned the questionnaire, corresponding to a response rate of 56.8%. The adoption rate of medication alert systems in hospital outpatient departments increased from less than 10% in 1997-95.83% in 2012. Approximately two-thirds of the hospitals developed and maintained the alert systems independently or collaboratively with vendors. Teaching and large hospitals tended to develop more advanced alert functions such as drug-drug interaction functions. Improving the safety and quality of pharmaceutical services and meeting the policy requirements are reasons for hospitals to establish medication alert systems. CONCLUSION: The adoption rate of medication alert systems reached 95% in accredited general hospitals in Taiwan. Government policy and available health information professionals and vendors may somewhat contribute to the high adoption rate.

Development of a Standardized Rating Tool for Drug Alerts to Reduce Information Overload.

BACKGROUND: A well-known problem in current clinical decision support systems (CDSS) is the high number of alerts, which are often medically incorrect or irrelevant. This may lead to the so-called alert fatigue, an overriding of alerts, including those that are clinically relevant, and underuse of CDSS in general. OBJECTIVES: The aim of our study was to develop and to apply a standardized tool that allows its users to evaluate the quality of system-generated drug alerts. The users' ratings can subsequently be used to derive recommendations for developing a filter function to reduce irrelevant alerts. METHODS: We developed a rating tool for drug alerts and performed a web-based evaluation study that also included a user review of alerts. In this study the following categories were evaluated: "data linked correctly", "medically correct", "action required", "medication change", "critical alert", "information gained" and "show again". For this purpose, 20 anonymized clinical cases were randomly selected and displayed in our customized CDSS research prototype, which used the summary of product characteristics (SPC) for alert generation. All the alerts that were provided were evaluated by 13 physicians. The users' ratings were used to derive a filtering algorithm to reduce overalerting. RESULTS: In total, our CDSS research prototype generated 399 alerts. In 98 % of all alerts, medication data were rated as linked correctly to drug information; in 93 %, the alerts were assessed as "medically correct"; 19.5 % of all alerts were rated as "show again". The interrater-agreement was, on average, 68.4 %. After the application of our filtering algorithm, the rate of alerts that should be shown again decreased to 14.8 %. CONCLUSIONS: The new standardized rating tool supports a standardized feedback of user-perceived clinical relevance of CDSS alerts. Overall, the results indicated that physicians may consider the majority of alerts formally correct but clinically irrelevant and override them. Filtering may help to reduce overalerting and increase the specificity of a CDSS.

Evaluating the accuracy of electronic pediatric drug dosing rules.

OBJECTIVE: To determine the accuracy of vendor-supplied dosing eRules for pediatric medication orders. Inaccurate or absent dosing rules can lead to high numbers of false alerts or undetected prescribing errors and may potentially compromise safety in this already vulnerable population. MATERIALS AND METHODS: 7 months of medication orders and alerts from a large pediatric hospital were analyzed. 30 medications were selected for study across 5 age ranges and 5 dosing parameters. The resulting 750 dosing rules from a commercial system formed the study corpus and were examined for accuracy against a gold standard created from traditional clinical resources. RESULTS: Overall accuracy of the rules in the study corpus was 55.1% when the rules were transformed to fit a priori age ranges. Over a pediatric lifetime, the dosing rules were accurate an average of 57.6% of the days. Dosing rules pertaining to the newborn age range were as accurate as other age ranges on average, but exhibited more variability. Daily frequency dosing parameters showed more accuracy than total daily dose, single dose minimum, or single dose maximum. DISCUSSION: The accuracy of a vendor-supplied set of dosing eRules is suboptimal when compared with traditional dosing sources, exposing a gap between dosing rules in commercial products and actual prescribing practices by pediatric care providers. More research on vendor-supplied eRules is warranted in order to understand the effects of these products on safe prescribing in children.