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First published January 31, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1727
Journal of the American Medical Informatics Association 2005;12(3):269-274
© 2005 American Medical Informatics Association

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Submitted on October 29, 2004
Accepted on January 24, 2005

A Trial of Automated Decision Support Alerts for Contraindicated Medications Using Computerized Physician Order Entry

William L. Galanter MD, PhD1*, Robert Didomenico PharmD2, and Audrius Polikaitis PhD3

Affiliation of the authors: 1 College of Medicine, Section of General Internal Medicine, University of Illinois at Chicago, Chicago, IL; 2 Department of Pharmacy Practice, University of Illinois Hospital, Chicago, IL; 3 Information Technology Services, University of Illinois Hospital, Chicago, IL

* To whom correspondence should be addressed.

Background Automated clinical decision support has shown promise in reducing medication errors, however, clinicians often do not comply with alerts. As renal insufficiency is a common source of medication errors, we studied a trial of alerts designed to reduce inpatient administration of medications contraindicated due to renal insufficiency.

Methods A minimum safe creatinine clearance was established for each inpatient formulary medication. Alerts recommending cancellation appeared when a medication order was initiated for a patient whose estimated creatinine clearance was less than the minimum safe creatinine clearance for the medication. Administration of medications in patients with creatinine clearances less than the medications minimum safe clearance were studied for 14 months after, and 4 months prior to alert implementation. In addition, the impact of patient age, gender, degree of renal dysfunction, time of day, as well as duration of housestaff training on the likelihood of housestaff compliance with the alerts was examined.

Results The likelihood of a patient receiving at least one dose of contraindicated drug after the order was initiated decreased from 89% to 47% (P<0.0001) after alert implementation. Analysis of the alerts seen by housestaff showed that alert compliance was higher in male patients; 57% vs.38%, P=0.02, increased with the duration of housestaff training, P=0.04 and increased in patients with worsening renal function, P=0.007.

Conclusion Alerts were effective in decreasing the ordering and administration of drugs contraindicated due to renal insuffiency. Compliance with the alerts was higher in male patients, increased with the duration of housestaff training and increased in patients with more severe renal dysfunction.




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