title: Potential safety gaps in order entry and automated drug alerts: a nationwide survey of VA physician self-reported practices with computerized order entry.
abstract: OBJECTIVE
  Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology.
  
  
  METHODS
  Cross-sectional, national survey of Veterans Administration physicians practicing in various specialties.
  
  
  METHODS
  Thirty-five question instrument was divided into 4 content domains. Response options included dichotomous, numeric, multiple choices, and Likert-like scales. Statistical methods included logistic regression.
  
  
  RESULTS
  The adjusted response rate was 1543 of 3588 (43%). Almost all providers (90%) felt that the VA electronic prescribing system, including its order checks, improved prescribing safety to some degree. Most respondents (72%) reported that they always or almost always document outside medications in a clinic note, although only 44% always or almost always entered outside medications in the non-VA medication data field. Most physicians (88%) who encountered serious allergic or adverse drug reactions reported either notifying a pharmacist or entering the information in the allergies/adverse reactions field. Generalists and physicians with higher numbers of prescriptions were more likely to enter relevant data into the electronic medical record (or notify a pharmacist, in the case of adverse reactions). In addition, 48% of providers described critical drug-drug interaction alerts as very useful; medical specialists found these less useful, whereas surgical specialists found these more useful when compared with generalists.
  
  
  CONCLUSIONS
  Survey was conducted within a single healthcare system.
  
  
  CONCLUSIONS
  Computerized provider order entry and related order checks are perceived to improve prescribing safety; however, provider entry of some relevant information into the appropriate electronic fields may not be optimal.
authors.affiliation: VA Greater Los Angeles Healthcare System, University of California Los Angeles, Los Angeles, USA. Jeffrey.Spina@va.gov
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Spina
authors.forename: Peter A
authors.initials: PA
authors.lastname: Glassman
authors.forename: Barbara
authors.initials: B
authors.lastname: Simon
authors.forename: Andrew
authors.initials: A
authors.lastname: Lanto
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.forename: Francesca
authors.initials: F
authors.lastname: Cunningham
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
mesh_terms: D001331:Automation; D016303:Clinical Pharmacy Information Systems; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical; D004347:Drug Interactions; D055695:Electronic Prescribing; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D017010:Reminder Systems; D012449:Safety; D011795:Surveys and Questionnaires; D014481:United States