ArticleJournal of the American Medical Informatics Association : JAMIA2021
Renal medication-related clinical decision support (CDS) alerts and overrides in the inpatient setting following implementation of a commercial electronic health record: implications for designing more effective alerts.
Article in Journal of the American Medical Informatics Association : JAMIA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- Thinking critically about AI documentation quality in primary care.BMJ quality & safety · 2026Article
- Integrating clinical decision support systems, nursing vigilance, and physician prescribing patterns to reduce preventable adverse drug events: a structured evidence-based narrative review on human-AI interface in medication safety.Frontiers in digital health · 2026Review
- The Value of Clinical Decision Support in Healthcare: A Focus on Screening and Early Detection.Diagnostics (Basel, Switzerland) · 2025Review
- Antihypertensive drug-related problems in Vietnamese ambulatory care.Scientific reports · 2025Article
- Developing practical recommendations for drug-disease interactions in patients with hypertension.Frontiers in pharmacology · 2024Article
- Clinician Response to Pharmacogenetic Clinical Decision Support Alerts.Clinical pharmacology and therapeutics · 2023Article
- Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Behavioral Health Decision Support Systems and User Interface Design in the Emergency Department.Applied clinical informatics · 2023Article
- Identification of Medication Prescription Errors and Factors of Clinical Relevance in 314 Hospitalized Patients for Improved Multidimensional Clinical Decision Support Algorithms.Journal of clinical medicine · 2023Article
- Improving healthcare value: Lessons learned from the first decade of Choosing Wisely®.Journal of hospital medicine · 2023Article
- Appropriateness of Alerts and Physicians' Responses With a Medication-Related Clinical Decision Support System: Retrospective Observational Study.JMIR medical informatics · 2022Article
- A Qualitative Description of Clinician Free-Text Rationales Entered within Accountable Justification Interventions.Applied clinical informatics · 2022Article
- Using clinical decision support tools to increase defibrillator deactivations in dying patients.BMJ open quality · 2022Article
- Moving Beyond Tools and Building Bridges: Lessons Learned From a CKD Decision Support in Primary Care.Kidney medicine · 2022Article
- Impact of Kidney Failure Risk Prediction Clinical Decision Support on Monitoring and Referral in Primary Care Management of CKD: A Randomized Pragmatic Clinical Trial.Kidney medicine · 2022Article
- 'Improving smart medication management': an online expert discussion.BMJ health & care informatics · 2022Review
- Modulators Influencing Medication Alert Acceptance: An Explorative Review.Applied clinical informatics · 2022Review
- Looking back on the history of patient safety: an opportunity to reflect and ponder future challenges.BMJ quality & safety · 2022Article
- Medication Errors and Patient Safety: Evaluation of Physicians' Responses to Medication-Related Alert Overrides in Clinical Decision Support Systems.Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2021Article
- Low Efficacy of Medication Shortage Clinical Decision Support Alerts.Applied clinical informatics · 2021Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the appropriateness of medication-related clinical decision support (CDS) alerts associated with renal insufficiency and the potential/actual harm from overriding the alerts. MATERIALS AND
methodsOverride rate frequency was recorded for all inpatients who had a renal CDS alert trigger between 05/2017 and 04/2018. Two random samples of 300 for each of 2 types of medication-related CDS alerts associated with renal insufficiency-"dose change" and "avoid medication"-were evaluated by 2 independent reviewers using predetermined criteria for appropriateness of alert trigger, appropriateness of override, and patient harm.
resultsWe identified 37 100 "dose change" and 5095 "avoid medication" alerts in the population evaluated, and 100% of each were overridden. Dose change triggers were classified as 12.5% appropriate and overrides of these alerts classified as 90.5% appropriate. Avoid medication triggers were classified as 29.6% appropriate and overrides 76.5% appropriate. We identified 5 adverse drug events, and, of these, 4 of the 5 were due to inappropriately overridden alerts.
conclusionAlerts were nearly always presented inappropriately and were all overridden during the 1-year period studied. Alert fatigue resulting from receiving too many poor-quality alerts may result in failure to recognize errors that could lead to patient harm. Although medication-related CDS alerts associated with renal insufficiency had previously been found to be the most clinically beneficial alerts in a legacy system, in this system they were ineffective. These findings underscore the need for improvements in alert design, implementation, and monitoring of alert performance to make alerts more patient-specific and clinically appropriate.
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