VA study: Alert redesign reduced prescribing errors

Friday, October 17, 2014

Continuing on the theme of the importance of design in electronic health record (EHR) medication alerts (see my recent post here), Alissa Russ et al published a new study in JAMIA describing how an alert redesign reduced prescribing errors in a simulated environment at the VA.

The authors developed three clinical scenarios involving drug-allergy, drug-drug, and drug-disease alerts. They redesigned these alerts using known usability principles. Some of the changes included the following:

  • Combining multiple alerts into a single dialog box
  • Using a tabular format, with similar information presented in each column
  • Including the medication name in the alert header
  • Eliminating scrolling by making the dialog box large enough to fit all the content
  • Including links to relevant additional information

Twenty prescribers completed the study, including 14 physicians, 2 nurse practitioners, and 4 clinical pharmacists. The median number of prescribing errors was reduced from 4 errors with the old alert design to 2 errors with the new alert design – a statistically significant difference. There were a maximum of 11 errors that could have been made.

The authors also found higher satisfaction with the usability of the new alerts as well as a reduced perceived workload.

It’s important to note that the core content of the alerts didn’t change; only the design changed (including some wording changes). This study therefore provides further evidence that the design of the alerting system is an important factor in alert acceptance.

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