title: Reducing prescribing errors through creatinine clearance alert redesign.
abstract: BACKGROUND
  Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts.
  
  
  METHODS
  Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors.
  
  
  RESULTS
  There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently.
  
  
  CONCLUSIONS
  Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment.
authors.affiliation: School of Pharmacy, University of Kansas, Lawrence. Electronic address: bmelton2@kumc.edu.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Melton
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind; Regenstrief Institute, Inc, Indianapolis, Ind; Indiana University Center for Health Services and Outcomes Research, Indianapolis; College of Pharmacy, Purdue University, West Lafayette, Ind.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Zillich
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Russell
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind; Regenstrief Institute, Inc, Indianapolis, Ind; Indiana University Center for Health Services and Outcomes Research, Indianapolis.
authors.forename: Michael
authors.initials: M
authors.lastname: Weiner
authors.affiliation: Department of Veterans Affairs, Nephrology Services Central Texas, Temple.
authors.forename: M Sue
authors.initials: MS
authors.lastname: McManus
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, Calif; David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Spina
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Ind; Regenstrief Institute, Inc, Indianapolis, Ind; Indiana University Center for Health Services and Outcomes Research, Indianapolis; College of Pharmacy, Purdue University, West Lafayette, Ind.
authors.forename: Alissa L
authors.initials: AL
authors.lastname: Russ
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism*; D020000:Decision Support Systems, Clinical; D006804:Ergonomics; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D061214:Patient Safety; D017010:Reminder Systems; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Electronic health records; Evaluation; Health information technology; Patient safety; Renal disease