Drug-drug interaction alerts in electronic prescribing and medication dispensing systems

A multi-system comparison of interfaces

Project members - Macquarie University

Professor Johanna Westbrook
Professor and Director

Project members - external

Associate Professor Melissa Baysari
Associate Professor

Dr Wu Yi Zheng
Postdoctoral Research Fellow

External chief investigators:

David Lowenstein, Anmol Sandhu, Rosemary Burke, Eliza Kenny, Professor Richard Day

Project main description

Electronic prescribing systems (ePS) with decision support are increasingly being adopted by hospitals and general practices as a means of improving efficiency and safety of prescribing. Computerised alerts embedded in ePS for doctors are triggered at the point of prescribing and are designed to warn prescribers about possible errors in their orders, such as Drug-Drug interactions (DDIs).Similarly, alerts embedded in pharmacy dispensing systems are triggered at the point of dispensing and are designed to warn pharmacists about possible errors in prescriptions, including DDIs.While DDI alerts have the potential to reduce errors, in reality they are frequently overridden. A range of factors which may potentially impact on the effectiveness of DDI alerts have been identified. This study will explore one such factor: alert interface design.

Background

The quality of the alert interface, i.e. how the alert appears to the system user, has been shown to influence prescriber acceptance of computerised alerts.There is also some evidence to suggest that applying human factors principles to alert design can improve usability and prescribing outcomes. In 2011, a human factors tool, the I-MeDeSA (Instrument for evaluating human factors principles in medication-related decision support alerts), was developed as an approach to evaluate the quality of DDI alert interfaces.This tool has been used to evaluate DDI alerts in 14 electronic health record systems (EHRs) in the United States but no assessments of Australian DDI alerts have been performed.

Aims

To compare the DDI alert interfaces in four hospital ePS, two General Practitioner (GP) software systems, and two pharmacist medication dispensing systems currently in use in Australia, in terms of their compliance with human factors principles of alert design; and to determine whether alerts which are more compliant with human factors principles are viewed more favourably by doctors and pharmacists.

Design and Method

Part 1. Evaluation of DDI alert interfaces

The DDI alert interfaces used in the electronic prescribing systems and medication dispensing systems will be assessed using the I-MeDeSA tool.Two reviewers will use the I-MeDeSA tool to evaluate a major (or severe) DDI alert interface and if possible, a minor alert DDI interface in each system.

Part 2. Evaluation of user preferences

To determine whether alerts which are more compliant with human factors principles are viewed more favourably by prescribers, a short survey will be administered to prescribers, including hospital doctors, GPs, and hospital pharmacists. Participants will be presented with a screen shot of the major DDI alert ‘azathioprine + allopurinol’in each ePS and medication dispensing system (collected during Part 1) and asked to rank the alert interfaces from most to least preferred.

Project Details

This project is funded by NHMRC Program Grant

Related stream of research

Medication safety and eHealth

Electronic decision support and human factors in healthcare

Project status

Current

Centres related to this project

Centre for Health Systems and Safety Research