How to design computerized alerts to safe prescribing practices.
BACKGROUND
Medication errors and preventable adverse drug events are common, and about half of medication errors occur during medication ordering. This study was designed to develop and evaluate medication safety alerts and processes for educating prescribers about the alerts.


METHODS
At Kaiser Permanente Northwest, a group-model health maintenance organization where prescribers have used computerized order entry since 1996, qualitative interviews were conducted with 20 primary care prescribers.


RESULTS
Prescribers considered alerts helpful for providing prescribing and preventive health information. More than half the interviewees stated that it would be unwise to let clinicians control or avoid safety alerts. Common frustrations were (1) being delayed by the alert, (2) having difficulty interpreting the alert, and (3) receiving the same alert repeatedly. Most prescribers preferred small-group educational sessions tied to existing meetings and having local physicians conduct education sessions.


CONCLUSIONS
The findings were used to design a strategy for introducing and promoting the interventions, modifying the alert text and tools, and focusing the education on how clinicians could use the alerts effectively.
Feldstein
Adrianne
A
Center for Health Research, Kaiser Permanente, Portland, Oregon, USA. adrianne.c.feldstein@kpchr.org
Simon
Steven R
SR
Schneider
Jennifer
J
Krall
Michael
M
Laferriere
Dan
D
Smith
David H
DH
Sittig
Dean F
DF
Soumerai
Stephen B
SB
D001291:Attitude of Health Personnel; D016303:Clinical Pharmacy Information Systems; D003200:Computer User Training; D020000:Decision Support Systems, Clinical; D017598:Efficiency, Organizational; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008503:Medical Staff / Q000193:education / Q000523:psychology; D008508:Medication Errors / Q000517:prevention & control*; D009922:Oregon; D017010:Reminder Systems; D017751:Safety Management; D014861:Washington