HIMSS: Taming the duplicate alert beast
ORLANDO, Fla. -- In the three-month period from Sept. 1 to Dec. 1, 2009, more than 567,000 medication alerts sounded at Sisters of Mercy Health System in St. Louis. It’s no wonder “alert fatigue” had set in among physicians. During a poster presentation at HIMSS11, Physician Informaticist Michael Hunt, DO, explained revisions made to the medication alert process to trim the frequency of the alerts, helping physicians to better ‘tune in’ when the alerts sounded.
When it went live with its EMR, the health system utilized established best practices, gathering stakeholders from across the enterprise to define medication alerts and to determine how these alerts were applied throughout the system, says Hunt. Nevertheless, the process did not fully appreciate the patterns of physician medication ordering behavior.
“When we went live, physicians were very vocal about the uselessness of the medication alerts. They did not find value of the alerts toward the management of their patients; therefore, the alerts were ignored,” recalled Hunt. “Clearly, the implementation was not meeting the defined goal of improved patient care.”
Hunt and his colleagues returned to the drawing board. They started by analyzing the types of medication alerts. Next alerts were divided into several categories: drug/drug interactions; drug/food interactions; pregnancy and duplicate therapy. The team was unable to alter drug/drug or pregnancy alerts. Instead, they chose to focus on duplicate therapy alerts.
The group focused on a 1,000 bed hospital where physicians were struggling with the volume of alerts. They found that a total of 17,500 physician-specific alerts were fired at the site within a single week.
The most common alerts being fired were the duplicate therapy alerts for narcotics; hypnotics; anti-emetics and antithrombotic agents. Hunt and team reviewed the definitions for duplicate therapy alerts. They discovered that clinical practice typically involved more medication orders from within the therapeutic class.
It was determined the electronic system did not comprehend clinical practice. That is, if a physician were switching a patient from intravenous narcotics to oral narcotics, the system recognized the change as three distinct orders: the original intravenous narcotic order; the order to discontinue the intravenous route and the order to change to the oral narcotic. The system was unable to distinguish the difference between an original medication order and the order to discontinue the original order while changing the route of administration of the medication.
Hunt resolved the issue by readjusting the definitions of duplicate orders. This reduced the number of duplicate alerts by 33 percent; consequently, physicians were happier, explained Hunt. The expectation is physicians are seeing less frequent and more meaningful alerts. Future plans include a review of the impact of these efforts on patient care.
HIMSS posters may be viewed in Exhibit Hall E during Exhibit Hall hours. Poster presenters will be stationed at their poster sessions Monday, Feb. 21 from 4:00 pm to 5:00 p.m. and Tuesday Feb. 22 from 12:00 pm to 1:00 p.m.
When it went live with its EMR, the health system utilized established best practices, gathering stakeholders from across the enterprise to define medication alerts and to determine how these alerts were applied throughout the system, says Hunt. Nevertheless, the process did not fully appreciate the patterns of physician medication ordering behavior.
“When we went live, physicians were very vocal about the uselessness of the medication alerts. They did not find value of the alerts toward the management of their patients; therefore, the alerts were ignored,” recalled Hunt. “Clearly, the implementation was not meeting the defined goal of improved patient care.”
Hunt and his colleagues returned to the drawing board. They started by analyzing the types of medication alerts. Next alerts were divided into several categories: drug/drug interactions; drug/food interactions; pregnancy and duplicate therapy. The team was unable to alter drug/drug or pregnancy alerts. Instead, they chose to focus on duplicate therapy alerts.
The group focused on a 1,000 bed hospital where physicians were struggling with the volume of alerts. They found that a total of 17,500 physician-specific alerts were fired at the site within a single week.
The most common alerts being fired were the duplicate therapy alerts for narcotics; hypnotics; anti-emetics and antithrombotic agents. Hunt and team reviewed the definitions for duplicate therapy alerts. They discovered that clinical practice typically involved more medication orders from within the therapeutic class.
It was determined the electronic system did not comprehend clinical practice. That is, if a physician were switching a patient from intravenous narcotics to oral narcotics, the system recognized the change as three distinct orders: the original intravenous narcotic order; the order to discontinue the intravenous route and the order to change to the oral narcotic. The system was unable to distinguish the difference between an original medication order and the order to discontinue the original order while changing the route of administration of the medication.
Hunt resolved the issue by readjusting the definitions of duplicate orders. This reduced the number of duplicate alerts by 33 percent; consequently, physicians were happier, explained Hunt. The expectation is physicians are seeing less frequent and more meaningful alerts. Future plans include a review of the impact of these efforts on patient care.
HIMSS posters may be viewed in Exhibit Hall E during Exhibit Hall hours. Poster presenters will be stationed at their poster sessions Monday, Feb. 21 from 4:00 pm to 5:00 p.m. and Tuesday Feb. 22 from 12:00 pm to 1:00 p.m.