Leslie Dan Faculty of Pharmacy

Permanent URI for this communityhttps://hdl.handle.net/1807/68860

The Leslie Dan Faculty of Pharmacy is Canada’s largest pharmacy school and has a world class reputation in education and research. Educational programming is at the heart of the Leslie Dan Faculty of Pharmacy and it currently offers a number of cutting-edge educational programs.

The research conducted by students, faculty, research associates and postdoctoral fellows at the Leslie Dan Faculty of Pharmacy focuses on drugs and medications. The results of this research have a profound impact in drug therapy on both the molecular level and on entire populations.

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Browsing Leslie Dan Faculty of Pharmacy by Subject "Alert Fatigue, Health Personnel"

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    Challenges with suppressing drug interaction alerts in an electronic health record-embedded computerized provider order entry system
    (2020-03-10) Chan, Huyee; Kwan, Janice; Wyllie, Andrew; Thwaites, Crystal; Zanchetta, Cristina; Coleman, Brenda; Chiu, Tabitha
    RATIONALE: Alert fatigue can result in failure to respond to clinically relevant alerts. Alert override rates nearing 100% in electronic health record-embedded computerized provider order entry (CPOE) reported in literature suggests that many alerts do not influence decisions. Our initial objective was to identify and suppress clinically irrelevant drug interaction alerts at our institution to reduce alert fatigue. The objective of this paper is to explore the challenges we encountered with implementing our alert suppression intervention. METHODS: We identified the most frequently fired and overridden CPOE alerts at a 442-bed urban academic health sciences center. We planned to conduct an interrupted time series analysis to determine the impact of suppressing opioid drug interaction alerts on a) the total number of alerts fired and overridden, b) average time users spent resolving alerts, and c) rate of opioid adverse events. We described our institution’s experience with this planned intervention, the key challenges of suppressing alerts and the limitations of quantifying alert fatigue in a CPOE system. RESULTS: Our primary challenge was the inability to remove the targeted alerts without also removing other alerts felt to be clinically relevant firing simultaneously with the alerts targeted for suppression. We were also constrained by the inability to selectively suppress alerts for specific user groups. Individual clinicians valued the alerts differently depending on contextual workflow making consensus on which alerts to suppress difficult to achieve. Data for time-based alert fatigue metrics were challenging to obtain and did not accurately measure user cognitive load. CONCLUSION: We learned the following lessons: 1) Hospitals would benefit from systems with granular alert customizability to ensure alerts fire for the right user at the appropriate time and in the appropriate workflow; 2) Efforts to reduce alert fatigue in CPOE must consider specific user workflows ; 3) Hospitals should consider immediate and long-term consequences before adding or suppressing alerts, with users surveyed before and after suppression to understand its impact on clinical workflow for continuous quality improvement; and 4) Existing time-based metrics can be used to quantify alert fatigue but are not adequate proxy measures for users’ cognitive load.