AHRQ Study: Better Drug Interaction Alerts Improve Patient Safety

Using consistent terms and definitions to indicate the potential seriousness of drug-drug interactions (DDI) and plainly identifying interacting drug pairs are among the recommendations to improve patient safety in an AHRQ-funded study. Researchers recommended increasing the usability and consistency of DDI decision support tools to help reduce “alert fatigue,” which can cause safety alerts to be ignored because they are triggered so often. The researchers—a group of 24 individuals that included clinical, informatics and computer interface design experts—identified seven core elements that should be included with DDI decision support. Their recommendations focused on consistent use of terminology, symbols/icons, color, minimal text, formatting, content and reporting standards. The study, “Recommendations To Improve the Usability of Drug-Drug Interaction Clinical Decision Support Alerts,” and abstract were published March 30 in the Journal of the American Medical Informatics Association.

2015 Mar 30. pii: ocv011. doi: 10.1093/jamia/ocv011. [Epub ahead of print]

Recommendations to Improve the Usability of Drug-Drug Interaction Clinical Decision Support Alerts.

Payne TH1, Hines LE2, Chan RC3, Hartman S4, Kapusnik-Uner J5, Russ AL6, Chaffee BW7, Hartman C8, Tamis V9, Galbreth B10, Glassman PA11, Phansalkar S12, van der Sijs H13, Gephart SM14, Mann G15, Strasberg HR12, Grizzle AJ16, Brown M2, Kuperman GJ17, Steiner C18, Sullins A19, Ryan H19, Wittie MA20,Malone DC21.

Author information

Abstract

OBJECTIVE:

To establish preferred strategies for presenting drug-drug interaction (DDI) clinical decision support alerts.

MATERIALS AND METHODS:

A DDI Clinical Decision Support Conference Series included a workgroup consisting of 24 clinical, usability, and informatics experts representing academia, health information technology (IT) vendors, healthcare organizations, and the Office of the National Coordinator for Health IT. Workgroup members met via web-based meetings 12 times from January 2013 to February 2014, and two in-person meetings to reach consensus on recommendations to improve decision support for DDIs. We addressed three key questions: (1) what, how, where, and when do we display DDI decision support? (2) should presentation of DDI decision support vary by clinicians? and (3) how should effectiveness of DDI decision support be measured?

RESULTS:

Our recommendations include the consistent use of terminology, visual cues, minimal text, formatting, content, and reporting standards to facilitate usability. All clinicians involved in the medication use process should be able to view DDI alerts and actions by other clinicians. Override rates are common but may not be a good measure of effectiveness.

DISCUSSION:

Seven core elements should be included with DDI decision support. DDI information should be presented to all clinicians. Finally, in their current form, override rates have limited capability to evaluate alert effectiveness.

CONCLUSION:

DDI clinical decision support alerts need major improvements. We provide recommendations for healthcare organizations and IT vendors to improve the clinician interface of DDI alerts, with the aim of reducing alert fatigue and improving patient safety.