| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on December 22, 2004
Accepted on March 6, 2005
Affiliation of the authors: 1 Center for Healthcare Quality and Effectiveness, BJC Healthcare and the Department of Medicine, Washington University School of Medicine, Saint Louis, MO; 2 St. Louis College of Pharmacy, Saint Louis, MO; 3 Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, MO; 4 Department of Pharmacy, Christian Hospital, Saint Louis, MO
* To whom correspondence should be addressed.
A commercial rule base (Cerner Multum) was used to identify medication orders exceeding recommended dosage limits at five hospitals within BJC HealthCare, an integrated healthcare system. During initial testing, clinical pharmacists determined there were an excessive number of nuisance and clinically insignificant alerts, with an overall alert rate of 9.2%. A method for customizing the commercial rule base was implemented to increase rule specificity for problematic rules. The system was subsequently deployed at 2 facilities and achieved alerts rates of less than 1%. Pharmacists screened these alerts and contacted ordering physicians in 21%. Physicians made therapeutic changes in 38% of alerts presented to them. By applying simple techniques to customize rules, commercial rule bases can be used to rapidly deploy a safety net to screen drug orders for excessive dosages, while preserving the rule architecture for later implementations of more finely tuned clinical decision support.
This article has been cited by other articles:
 |
|
 |
|
  C.-P. Lin, T. H. Payne, W. P. Nichol, P. J. Hoey, C. L. Anderson, and J. H. Gennari Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record System J. Am. Med. Inform. Assoc., September 1, 2008; 15(5): 620 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. van der Sijs, J. Aarts, T. van Gelder, M. Berg, and A. Vulto Turning Off Frequently Overridden Drug Alerts: Limited Opportunities for Doing It Safely J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 439 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. Field, P. Rochon, M. Lee, L. Gavendo, S. Subramanian, S. Hoover, J. Baril, and J. Gurwitz Costs Associated with Developing and Implementing a Computerized Clinical Decision Support System for Medication Dosing for Patients with Renal Insufficiency in the Long-term Care Setting J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 466 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. K. Killelea, R. Kaushal, M. Cooper, and G. J. Kuperman To What Extent Do Pediatricians Accept Computer-Based Dosing Suggestions? Pediatrics, January 1, 2007; 119(1): e69 - e75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Kuperman, R. M. Reichley, and T. C. Bailey Using Commercial Knowledge Bases for Clinical Decision Support: Opportunities, Hurdles, and Recommendations J. Am. Med. Inform. Assoc., July 1, 2006; 13(4): 369 - 371. [Full Text] [PDF]
|
|
|
|
|
|
N. R. Shah, A. C. Seger, D. L. Seger, J. M. Fiskio, G. J. Kuperman, B. Blumenfeld, E. G. Recklet, D. W. Bates, and T. K. Gandhi Improving Acceptance of Computerized Prescribing Alerts in Ambulatory Care J. Am. Med. Inform. Assoc., January 1, 2006; 13(1): 5 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Miller, R. M. Gardner, K. B. Johnson, and G. Hripcsak Clinical Decision Support and Electronic Prescribing Systems: A Time for Responsible Thought and Action J. Am. Med. Inform. Assoc., July 1, 2005; 12(4): 403 - 409. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
