Ammenwerth Elske, Hackl Werner O, Riedmann Daniel, Jung Martin
Institute for Health Information Systems, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
Stud Health Technol Inform. 2011;169:920-4.
Computerized Physician Order Entry (CPOE) Systems can reduce the number of medication errors and Adverse Drug Events (ADEs). However, studies have shown that users often override alerts, as they feel these are too unspecific for the given patient context. It is unclear, however, how alerts could be contextualized, that is adapted to the clinical context. Based on a literature search, we developed a list of 20 possible context factors. We asked 69 international CPOE researchers and 120 physicians from four hospitals in two countries to judge the usefulness of each factor. Researchers judged the following factors as most important: 1.) Severity of the effect, 2.) Clinical status of the patient, 3.) Probability of occurrence, 4.) Risk factors of the patient, 5.) Strength of evidence. Physicians judged the following factors as most important: Severity of the effect, clinical status of the patients, complexity of the case, and class of drug. These top-ranked context factors could be used to re-design the way alerts are presented in CPOE systems, to increase sensitivity of alerts, to reduce overriding rates, and to improve medication safety.
计算机化医师医嘱录入（CPOE）系统可以减少用药错误和药物不良事件（ADEs）的数量。然而，研究表明，用户经常忽略警报，因为他们觉得这些警报对于特定的患者情况来说不够具体。然而，尚不清楚如何将警报情境化，即如何使其适应临床情境。基于文献检索，我们列出了20个可能的情境因素。我们询问了69名国际CPOE研究人员和来自两个国家四家医院的120名医生，以判断每个因素的有用性。研究人员认为以下因素最为重要：1.）效应的严重程度，2.）患者的临床状况，3.）发生概率，4.）患者的风险因素，5.）证据强度。医生认为以下因素最为重要：效应的严重程度、患者的临床状况、病例的复杂性和药物类别。这些排名靠前的情境因素可用于重新设计CPOE系统中警报的呈现方式，以提高警报的敏感性，降低忽略率，并提高用药安全性。
