title: Nature and management of duplicate medication alerts.
abstract: OBJECTIVE
  To investigate the nature of duplicate medication (DM) alerts, their management by community pharmacists, and potential characteristics of DM alerts that lead to interventions by pharmacists.
  
  
  METHODS
  Observational study in 53 community pharmacies. Each pharmacist registered the nature and management of 24 DM alerts on a structured form.
  
  
  RESULTS
  On average, the clinical decision support systems generated 20.4 DM alerts per 100 dispensed drugs. In half of the 1272 registered alerts, the pharmacists judged that there was no risk for concurrent use of both prescriptions. In 32% of the alerts, the DM alert was generated for an intentional combination. In 17% of the alerts, there was a risk for unintentional concurrent use. In 32% of the alerts the pharmacists decided that one or more actions were needed: the electronic patient record was updated in 15% of the alerts and in 19% of the alerts the pharmacists performed an external action-for example, informing the patient or modifying the prescription (including 5 therapeutic prescription modifications and 22 logistic prescription modifications). Alerts concerning first dispensing were more likely to be followed by an external action than alerts concerning refills (40% vs 14%, P < .001).
  
  
  CONCLUSIONS
  In community pharmacy, prescription modifications based on DM alerts are rare, but DM alerts lead with some regularity to other actions-for example, patient instruction and update of the electronic patient record. As the current DM alerts are diverse and nonspecific in detecting situations where external action is considered relevant, other ways of alerting should therefore be considered.
authors: SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands m.heringa@stevenshof.nl.
authors: Mette
authors: M
authors: Heringa
authors: SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands.
authors: Annemieke
authors: A
authors: Floor
authors: Royal Dutch Pharmacists Association (KNMP), The Hague, the Netherlands.
authors: Willemijn M
authors: WM
authors: Meijer
authors: Royal Dutch Pharmacists Association (KNMP), The Hague, the Netherlands Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, Nijmegen, the Netherlands.
authors: Peter A G M
authors: PA
authors: De Smet
authors: SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands.
authors: Marcel L
authors: ML
authors: Bouvy
mesh_terms: D020000:Decision Support Systems, Clinical; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors; D009426:Netherlands; D010594:Pharmacies
keywords: clinical decision support systems; community pharmacy services; duplicate medication; medical order entry systems; medication errors