Reduction of clinical support warnings through recategorization of severity levels [Notes]

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Reduction of clinical support warnings through recategorization of severity levels Crystal Parke?, Elizabeth Santiago, Brent Zussy and Dusko Klipa

Crystal Parke, Pharm.D., is Assistant Professor, School of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee; at the time of writing, she was Postgraduate Year 1 Pharmacy Resident, St. Vincent’s Medical Center–Riverside, Jacksonville, FL. Elizabeth Santiago, Pharm.D., M.B.A., is Pharmacy Manager, St. Vincent’s Medical Center–Clay County, Middleburg, FL. Brent Zussy, Pharm.D., is Pharmacy Informaticist, Ascension Health Information Services, Jacksonville, FL. Dusko Klipa, Pharm. D., BCPS, is Pharmacy Operations Manager, St. Vincent’s Medical Center–Riverside. Address correspondence to Dr. Parke (crystal.parke{at}famu.edu). Abstract Purpose Study results indicating that non–clinically significant alerts generated by clinical support systems can be reduced by recategorizing alert severity levels, thereby decreasing alert fatigue, are presented.

Methods In a single-site retrospective pre–post study, all drug–drug interaction alerts displayed by a medical center’s clinical support system over a three-month baseline period were evaluated by a multidisciplinary expert panel. Based on a review of pharmaceutical package inserts and other evidence, the panel reduced the severity ranking of 99 of the 201 most frequently triggered alerts with the aim of reducing nonactionable alerts (i.e., alerts viewed but not resulting in a clinical intervention such as the discontinuation of a medication, a dose reduction, or the ordering of a laboratory test). Alert frequencies and types during the baseline period and a one-month period after adjustment of the alert severity rankings were compared to characterize the distribution of alert override responses.

Results Comparison of drug–drug interaction alerts before (n = 8023) and after (n = 7270) alert recategorization indicated significant differences in pharmacists’ documentation of override responses in four evaluated categories (p < 0.001 for all comparisons); notably, alerts overrides in the “not clinically significant” category declined 22%. No significant difference was detected in the numbers of reported medication errors related to clinically significant drug–drug interaction alerts before and after alert recategorization.

Conclusion Reducing the number of nonactionable drug–drug interaction alerts by recategorizing alert severity levels decreased alert overrides by 6%.

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? Previous | Next Article ? Table of Contents This Article doi: 10.2146/ajhp140095 American Journal of Health-System Pharmacy January 15, 2015 vol. 72 no. 2 144-148 ? Abstract Full Text Full Text (PDF) Classifications Print Content Notes Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eLetters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager eLetters Submit an eLetter No eLetters published Citing Articles Load citing article information Google Scholar Articles by Parke, C. Articles by Klipa, D. PubMed PubMed citation Articles by Parke, C. Articles by Klipa, D. Related Content Load related web page information Social Bookmarking CiteULike Delicious Digg Facebook Google+ Reddit Twitter What's this?

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