The Effect of Automated Alerts on Provider Ordering Behavior in an Outpatient Setting

Background: Computerized order entry systems have the potential to prevent medication errors and decrease adverse drug events with the use of clinical-decision support systems presenting alerts to providers. Despite the large volume of medications prescribed in the outpatient setting, few studies have assessed the impact of automated alerts on medication errors related to drug–laboratory interactions in an outpatient primary-care setting. Methods and Findings: A primary-care clinic in an integrated safety net institution was the setting for the study. In collaboration with commercial information technology vendors, rules were developed to address a set of drug–laboratory interactions. All patients seen in the clinic during the study period were eligible for the intervention. As providers ordered medications on a computer, an alert was displayed if a relevant drug–laboratory interaction existed. Comparisons were made between baseline and postintervention time periods. Provider ordering behavior was monitored focusing on the number of medication orders not completed and the number of rule-associated laboratory test orders initiated after alert display. Adverse drug events were assessed by doing a random sample of chart reviews using the Naranjo scoring scale. Conclusion: Providers will adhere to alerts and will use this information to improve patient care. Specifically, in response to drug–laboratory interaction alerts, providers will significantly increase the ordering of appropriate laboratory tests. There may be a concomitant change in adverse drug events that would require a larger study to confirm. Implementation of rules technology to prevent medication errors could be an effective tool for reducing medication errors in an outpatient setting. A computerized order entry system that alerted providers to potential problems was shown to be able to influence prescribing practice. Background: All drugs have unwanted side effects (also known as adverse drug events), and when drugs are combined the chances of side effects increase. It is almost impossible for individual physicians to keep up to date with all possible drug effects. Increasingly, prescription orders and patient records are transmitted and stored on computers rather than being handwritten. As well as improving their legibility, computer writing of prescriptions also makes it possible to design programs that look at a patient's record when the prescription is written and that check for any possible problems. Why Was This Study Done?: The authors wanted to investigate whether such a program could be used in an outpatient setting to change the behavior of physicians and ultimately to reduce the number of adverse drug reactions. What Did the Researchers Do and Find?: In a single outpatient facility in Denver, Colorado, they designed a program to alert prescribers when one of five possible adverse events was likely to occur, or when the patient required further tests to establish whether the drug was likely to be safe. They tested the effect of the program by looking at what physicians did when the alerting system was switched off, and then when it was switched on. They found that it was possible to alter the behavior of prescribers by alerting them to possible problems; prescribers were more likely to stop a prescription or to order more tests when they were alerted. However, the study was too small to show for sure whether there was any true effect on adverse drug reactions. What Do These Findings Mean?: Programs such as this one might be useful in alerting prescribers to potential problems with the drugs they are intending to prescribe. However, further work will need to be done to see if these programs can reduce the adverse events that patients experience, and whether they will work in other hospitals and clinics. Where Can I Get More Information Online?: The US Web site MedlinePlus has a page of links on patient issues such as adverse reactions: