Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.

Autor: Wong A; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; MCPHS University, Boston, MA, USA., Amato MG; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; MCPHS University, Boston, MA, USA., Seger DL; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Partners HealthCare, Wellesley, Boston, MA, USA., Slight SP; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; School of Medicine, Pharmacy and Health, The University of Durham, Stockton on Tees, Durham, UK; Newcastle University, Newcastle-upon-Tyne, UK., Beeler PE; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Research Center for Medical Informatics, University Hospital, Zurich, Switzerland; Harvard Medical School, Boston, MA, USA., Dykes PC; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Fiskio JM; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Partners HealthCare, Wellesley, Boston, MA, USA., Silvers ER; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Partners HealthCare, Wellesley, Boston, MA, USA., Orav EJ; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Eguale T; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; MCPHS University, Boston, MA, USA., Bates DW; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: dbates@partners.org.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2017 Jun; Vol. 39, pp. 156-161. Date of Electronic Publication: 2017 Feb 20.
DOI: 10.1016/j.jcrc.2017.02.027
Abstrakt: Purpose: Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU.
Materials and Methods: We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that resulted from the overridden alert.
Results: A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n=366), with an increased risk of ADEs associated with inappropriately overridden alerts (p=0.0078).
Conclusions: The appropriateness of medication-related clinical decision support overrides in the ICU varied substantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.
(Copyright © 2017. Published by Elsevier Inc.)
Databáze: MEDLINE
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