title: Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records.
abstract: OBJECTIVE
  Electronic trigger detection tools hold promise to reduce Adverse drug event (ADEs) through efficiencies of scale and real-time reporting. We hypothesized that such a tool could automatically detect medication dosing errors as well as manage and evaluate dosing rule modifications.
  
  
  METHODS
  We created an order and alert analysis system that identified antibiotic medication orders and evaluated user response to dosing alerts. Orders associated with overridden alerts were examined for evidence of administration and the delivered dose was compared to pharmacy-derived dosing rules to confirm true overdoses. True overdose cases were reviewed for association with known ADEs.
  
  
  RESULTS
  Of 55 546 orders reviewed, 539 were true overdose orders, which lead to 1965 known overdose administrations. Documentation of loose stools and diarrhea was significantly increased following drug administration in the overdose group. Dosing rule thresholds were altered to reflect clinically accurate dosing. These rule changes decreased overall alert burden and improved the salience of alerts.
  
  
  CONCLUSIONS
  Electronic algorithm-based detection systems can identify antibiotic overdoses that are clinically relevant and are associated with known ADEs. The system also serves as a platform for evaluating the effects of modifying electronic dosing rules. These modifications lead to decreased alert burden and improvements in response to decision support alerts.
  
  
  CONCLUSIONS
  The success of this test case suggests that gains are possible in reducing medication errors and improving patient safety with automated algorithm-based detection systems. Follow-up studies will determine if the positive effects of the system persist and if these changes lead to improved safety outcomes.
authors: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Eric S
authors: ES
authors: Kirkendall
authors: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Michal
authors: M
authors: Kouril
authors: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Judith W
authors: JW
authors: Dexheimer
authors: Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Joshua D
authors: JD
authors: Courter
authors: Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Philip
authors: P
authors: Hagedorn
authors: Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Rhonda
authors: R
authors: Szczesniak
authors: Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio, USA.
authors: Dan
authors: D
authors: Li
authors: Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, USA.
authors: Rahul
authors: R
authors: Damania
authors: Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Thomas
authors: T
authors: Minich
authors: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: S Andrew
authors: SA
authors: Spooner
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D062787:Drug Overdose / Q000175:diagnosis / Q000517:prevention & control*; D004360:Drug Therapy, Computer-Assisted; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D057286:Electronic Health Records; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: CPOE; adverse drug event; clinical; decision support systems; electronic health record; electronic medical record; medical order entry system; patient safety; risk management