Paterno Marilyn D, Maviglia Saverio M, Gorman Paul N, Seger Diane L, Yoshida Eileen, Seger Andrew C, Bates David W, Gandhi Tejal K
Department of Information Systems, Partners Health Care System, Inc., 93 Worcester Street, Suite 201, Wellesley Hills, MA 02481, USA.
J Am Med Inform Assoc. 2009 Jan-Feb;16(1):40-6. doi: 10.1197/jamia.M2808. Epub 2008 Oct 24.
Few data exist measuring the effect of differentiating drug-drug interaction (DDI) alerts in computerized provider order entry systems (CPOE) by level of severity ("tiering"). We sought to determine if rates of provider compliance with DDI alerts in the inpatient setting differed when a tiered presentation was implemented.
We performed a retrospective analysis of alert log data on hospitalized patients at two academic medical centers during the period from 2/1/2004 through 2/1/2005. Both inpatient CPOE systems used the same DDI checking service, but one displayed alerts differentially by severity level (tiered presentation, including hard stops for the most severe alerts) while the other did not. Participants were adult inpatients who generated a DDI alert, and providers who wrote the orders. Alerts were presented during the order entry process, providing the clinician with the opportunity to change the patient's medication orders to avoid the interaction.
Rate of compliance to alerts at a tiered site compared to a non-tiered site.
We reviewed 71,350 alerts, of which 39,474 occurred at the non-tiered site and 31,876 at the tiered site. Compliance with DDI alerts was significantly higher at the site with tiered DDI alerts compared to the non-tiered site (29% vs. 10%, p < 0.001). At the tiered site, 100% of the most severe alerts were accepted, vs. only 34% at the non-tiered site; moderately severe alerts were also more likely to be accepted at the tiered site (29% vs. 10%).
Tiered alerting by severity was associated with higher compliance rates of DDI alerts in the inpatient setting, and lack of tiering was associated with a high override rate of more severe alerts.
在计算机化医嘱录入系统（CPOE）中，按严重程度级别（“分层”）区分药物相互作用（DDI）警报效果的相关数据较少。我们试图确定在住院环境中实施分层显示时，医护人员对DDI警报的依从率是否存在差异。
我们对2004年2月1日至2005年2月1日期间两家学术医疗中心住院患者的警报日志数据进行了回顾性分析。两个住院CPOE系统都使用相同的DDI检查服务，但其中一个按严重程度级别差异显示警报（分层显示，包括对最严重警报进行强制阻止），而另一个则不这样做。参与者为产生DDI警报的成年住院患者以及开具医嘱的医护人员。警报在医嘱录入过程中呈现，使临床医生有机会更改患者的用药医嘱以避免相互作用。
分层站点与非分层站点对警报的依从率。
我们审查了71350条警报，其中39474条发生在非分层站点，31876条发生在分层站点。与非分层站点相比，分层DDI警报站点对DDI警报的依从性显著更高（29%对10%，p<0.001）。在分层站点，100%的最严重警报被接受，而非分层站点仅为34%；分层站点对中度严重警报的接受可能性也更高（29%对10%）。
在住院环境中，按严重程度分层警报与更高的DDI警报依从率相关，而缺乏分层则与更严重警报的高忽略率相关。
