Observational studyJournal of the American Medical Informatics Association : JAMIA2015
Tailoring of alerts substantially reduces the alert burden in computerized clinical decision support for drugs that should be avoided in patients with renal disease.
Observational study in Journal of the American Medical Informatics Association : JAMIA, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Electronic Alerts for Acute Kidney Injury.Deutsches Arzteblatt international · 2017Pooled it
- Article
- Vulnerability of a New Zealand hospital computerised provider order entry system to prescribing error: a comparative study with other systems.Internal medicine journal · 2025Article
- Acute kidney injury associated with nephrotoxic drugs in critically ill patients: a multicenter cohort study using electronic health record data.Clinical kidney journal · 2023Article
- An e-Delphi study to obtain expert consensus on the level of risk associated with preventable e-prescribing events.British journal of clinical pharmacology · 2022Article
- Modulators Influencing Medication Alert Acceptance: An Explorative Review.Applied clinical informatics · 2022Review
- The use of a clinical decision support tool to assess the risk of QT drug-drug interactions in community pharmacies.Therapeutic advances in drug safety · 2021Article
- Development, Implementation, and Evaluation of a Personalized Machine Learning Algorithm for Clinical Decision Support: Case Study With Shingles Vaccination.Journal of medical Internet research · 2020Article
- Reducing Interruptive Alert Burden Using Quality Improvement Methodology.Applied clinical informatics · 2020Article
- Impact of a clinical decision support system for drug dosage in patients with renal failure.International journal of clinical pharmacy · 2018Article
- Determining Inappropriate Medication Alerts from "Inaccurate Warning" Overrides in the Intensive Care Unit.Applied clinical informatics · 2018Article
- Lower alert rates by clustering of related drug interaction alerts.Journal of the American Medical Informatics Association : JAMIA · 2017Article
- Computerized Clinical Decision Support: Contributions from 2015.Yearbook of medical informatics · 2016Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveElectronic alerts are often ignored by physicians, which is partly due to the large number of unspecific alerts generated by decision support systems. The aim of the present study was to analyze critical drug prescriptions in a university-based nephrology clinic and to evaluate the effect of different alerting strategies on the alert burden.
methodsIn a prospective observational study, two advanced strategies to automatically generate alerts were applied when medication regimens were entered for discharge letters, outpatient clinic letters, and written prescriptions and compared to two basic reference strategies. Strategy A generated alerts whenever drug-specific information was available, whereas strategy B generated alerts only when the estimated glomerular filtration rate of a patient was below a drug-specific value. Strategies C and D included further patient characteristics and drug-specific information to generate even more specific alerts.
resultsOverall, 1012 medication regimens were entered during the observation period. The average number of alerts per drug preparation in medication regimens entered for letters was 0.28, 0.080, 0.019, and 0.011, when using strategy A, B, C, or D (P<0.001, for comparison between the strategies), leading to at least one alert in 87.5%, 39.3%, 13.5%, or 7.81 % of the regimens. Similar average numbers of alerts were observed for medication regimens entered for written prescriptions.
conclusionsThe prescription of potentially hazardous drugs is common in patients with renal impairment. Alerting strategies including patient and drug-specific information to generate more specific alerts have the potential to reduce the alert burden by more than 90 %.
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