Understanding responses to a renal dosing decision support system in primary care.
Renal dosing clinical decision support (CDS) systems have demonstrated clinical effectiveness and potential benefits for patient outcomes. However, the high override rates consistently reported are problematic and undesirable. To understand providers' use patterns of renal dosing CDS, we investigated the override reasons obtained from primary care practices affiliated with two teaching hospitals. We selected a stratified random sample of 300 alerts and reviewed electronic medical records. Appropriateness criteria and an inter-rater reliability process were used. We found that two thirds of alerts were overridden inappropriately, and this proportion was similar for frequent over-riders as compared to the remainder of physicians. These findings imply that strategies are needed to convince providers to accept more clinically appropriate suggestions, though they need to be broadly targeted.
Nursing Department, Inha University, Incheon, South Korea.
Insook
I
Cho
Sarah P
SP
Slight
Karen C
KC
Nanji
Diane L
DL
Seger
Patricia
P
Dykes
David W
DW
Bates
D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D038622:Internationality; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data