Evidence map›Paper›PMID 31391313›Full record

Observational studyBMJ quality & safety2019

Automated detection of wrong-drug prescribing errors.

Bruce L Lambert, William Galanter, King Lup Liu, Suzanne Falck, Gordon Schiff, Christine Rash-Foanio, Kelly Schmidt, Neeha Shrestha, Allen J Vaida, Michael J Gaunt

Abstract readObservational Study
In one paragraph

Observational study in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Examining medication ordering errors using AHRQ network of patient safety databases.Journal of the American Medical Informatics Association : JAMIA · 2023
    Observational
  3. Using automated methods to detect safety problems with health information technology: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2023
    Article
  4. Conceptual considerations for using EHR-based activity logs to measure clinician burnout and its effects.Journal of the American Medical Informatics Association : JAMIA · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Bruce L LambertDepartment of Communication Studies and Center for Communication and Health, Northwestern University, Chicago, Illinois, USA bruce.lambert@northwestern.edu.
William GalanterDepartment of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
King Lup LiuIndependent Consultant, Chicago, Illinois, USA.
Suzanne FalckDepartment of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
Gordon SchiffDivision of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Christine Rash-FoanioDepartment of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA.
Kelly SchmidtDepartment of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA.
Neeha ShresthaDepartment of Communication Studies and Center for Communication and Health, Northwestern University, Chicago, Illinois, USA.ORCID 0000-0001-8249-5390
Allen J VaidaInstitute for Safe Medication Practices, Horsham, Pennsylvania, USA.
Michael J GauntInstitute for Safe Medication Practices, Horsham, Pennsylvania, USA.

Funding

Tools for Optimizing Medication Safety (TOP-MEDS)U19HS021093 · AHRQ · UNIVERSITY OF ILLINOIS AT CHICAGO · PI LAMBERT, BRUCE L. · 2011 to 2015
$4.3M
AHRQ HHS U19 HS021093
6 · The paper itself

Abstract

backgroundTo assess the specificity of an algorithm designed to detect look-alike/sound-alike (LASA) medication prescribing errors in electronic health record (EHR) data.

settingUrban, academic medical centre, comprising a 495-bed hospital and outpatient clinic running on the Cerner EHR. We extracted 8 years of medication orders and diagnostic claims. We licensed a database of medication indications, refined it and merged it with the medication data. We developed an algorithm that triggered for LASA errors based on name similarity, the frequency with which a patient received a medication and whether the medication was justified by a diagnostic claim. We stratified triggers by similarity. Two clinicians reviewed a sample of charts for the presence of a true error, with disagreements resolved by a third reviewer. We computed specificity, positive predictive value (PPV) and yield.

resultsThe algorithm analysed 488 481 orders and generated 2404 triggers (0.5% rate). Clinicians reviewed 506 cases and confirmed the presence of 61 errors, for an overall PPV of 12.1% (95% CI 10.7% to 13.5%). It was not possible to measure sensitivity or the false-negative rate. The specificity of the algorithm varied as a function of name similarity and whether the intended and dispensed drugs shared the same route of administration.

conclusionAutomated detection of LASA medication errors is feasible and can reveal errors not currently detected by other means. Real-time error detection is not possible with the current system, the main barrier being the real-time availability of accurate diagnostic information. Further development should replicate this analysis in other health systems and on a larger set of medications and should decrease clinician time spent reviewing false-positive triggers by increasing specificity.

Indexed as

AlgorithmsAcademic Medical CentersChicagoDatabases, FactualDrug PrescriptionsElectronic Health RecordsHumansMedication ErrorsMedication Systems, HospitalRetrospective Studiesdecision support, computerizedmedication safetypatient safetyquality improvement

Identifiers

PMID31391313
PMCPMC6837246

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.