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1Texas A&M University School of Veterinary Medicine and Biomedical Sciences and
2The School of Biomedical Informatics |The...
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Evaluation of Clinical Decision Support Alerts for Medications Contraindicated in Cancer Patients

Computerized provider order entry-based alert systems were created to advise health care providers when prescribing medications to patients. This tool is helpful when ordering medications for cancer patients, due to their intensified risk of experiencing drug interactions with cancer therapies. The purpose of the study was to describe alerts for contraindicated medications of cancer patients to understand reasons for alert overrides and to provide additional information for further study in improving clinical support systems.

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Evaluation of Clinical Decision Support Alerts for Medications Contraindicated in Cancer Patients

  1. 1. 1Texas A&M University School of Veterinary Medicine and Biomedical Sciences and 2The School of Biomedical Informatics |The University of Texas Health Science Center at Houston Elise G. Brune1, Dean F. Sittig PhD2, Allison B. McCoy PhD2 Evaluation of Clinical Decision Support Alerts for Medications Contraindicated in Cancer Patients Results Methods • We assessed e-prescription clinical decision support alerts from Allscripts Enterprise EHR at UT Physicians practice in Houston, TX. • We then compiled and analyzed using Microsoft Excel to identify characteristics of alert overrides. Summary of Conclusions Introduction • In addition to intensive therapies, cancer patients are frequently prescribed medications to treat comorbid illnesses. • Caution must be taken to prevent harmful drug interactions that may affect patient health. • Computerized provider order entry-based alert systems are a way to identify medication contraindications. • Patient safety is compromised when medication contraindication alerts are ignored and overridden. • Most medication contraindication alerts are overridden. • The abundance of alert overrides may be credited to insufficient training or poor understanding of alert system by health professionals. • Appropriate alert presentation, as well as tiered alerting systems may aid efforts in decreasing overrides. • Improvements in clinical decision support systems are imperative to patient safety. Acknowledgements This project was supported in part by the CPRIT Undergraduate Summer Cancer Research Program, a UTHealth Young Clinical and Translational Sciences Investigator Award (KL2 TR 000370-06A1), and NCRR Grant 3UL1RR024148. Please contact the senior author via email: amccoy1@tulane.edu Results • 117 cancer patients experienced a total of 214 contraindicated medication alerts. • 93% of alerts were overridden. • On average, each patient experienced 1.7 overridden alerts. • 83.2% of alerts were overridden and given no explanation by the health care provider. • Nurses and physicians overrode all presented alerts. • Health care providers in Obstetrics/Gynecology and Endocrinology overrode the majority of alerts. • Otolaryngology specialists experienced non-overrides the most. • Most alert overrides were experienced in September and the least in June. • Overridden and non-overridden alerts similarly peaked the greatest at 1:00 pm, followed by 9:00 am. 0 5 10 15 20 25 30 35 40 Obstetrics/Gynecology Endocrinology Family Medicine Internal Medicine Neurology Unknown Oncology Geriatrics Rheumatology Urology Dermatology Cardiology General Surgery Nephrology Pediatrics Cardiothoracic and Vascular Surgery Orthopedic Surgery Otolaryngology Pulmonary Medicine Plastic Surgery Number of Alerts ProviderSpecialty Alerts by Provider Specialty Overridden Not Overriden 0 10 20 30 40 50 60 70 NumberofAlerts Provider Type Alerts by Provider Type Overriden Not Overriden 0 5 10 15 20 25 30 0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 NumberofAlerts Time of Day Alerts by Time of Day Overriden Not Overriden 83% 5% 3% 2% 7% Alert Overrides by Reason No Explanation; Alert was overriden Benefit out weighs risk in this patient Low risk; appropriate warnings given to patient No reasonable alternatives for this patient No Explanation; Alert was not overriden 0 10 20 30 40 50 60 70 80 90 Absolute Contraindication Potential Contraindication Contraindication Caution NumberofAlerts Priority Alerts by Priority Overriden Not Overriden 0 5 10 15 20 25 30 NumberofAlerts Month Alerts by Month Overriden Not Overriden Objective The study was conducted to describe alerts for contraindicated medications of cancer patients and understand the reasoning for alert overrides in order to improve clinical support systems.

Computerized provider order entry-based alert systems were created to advise health care providers when prescribing medications to patients. This tool is helpful when ordering medications for cancer patients, due to their intensified risk of experiencing drug interactions with cancer therapies. The purpose of the study was to describe alerts for contraindicated medications of cancer patients to understand reasons for alert overrides and to provide additional information for further study in improving clinical support systems.

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