Reducing prescribing errors through creatinine clearance alert redesign

Brittany L. Melton, Alan J. Zillich, Scott A. Russell, Michael Weiner, M. Sue McManus, Jeffrey R. Spina, Alissa L. Russ

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts. Methods Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors. Results There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P =.001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P =.012 and P =.008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently. Conclusions Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment.

Original languageEnglish (US)
Pages (from-to)1117-1125
Number of pages9
JournalThe American Journal of Medicine
Volume128
Issue number10
DOIs
StatePublished - Oct 1 2015

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Creatinine
Kidney
Spironolactone
Allopurinol
Nurse Practitioners
Ibuprofen
Veterans
Pharmacists
Outpatients
Physicians

Keywords

  • Electronic health records
  • Evaluation
  • Health information technology
  • Patient safety
  • Renal disease

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Melton, B. L., Zillich, A. J., Russell, S. A., Weiner, M., McManus, M. S., Spina, J. R., & Russ, A. L. (2015). Reducing prescribing errors through creatinine clearance alert redesign. The American Journal of Medicine, 128(10), 1117-1125. https://doi.org/10.1016/j.amjmed.2015.05.033

Reducing prescribing errors through creatinine clearance alert redesign. / Melton, Brittany L.; Zillich, Alan J.; Russell, Scott A.; Weiner, Michael; McManus, M. Sue; Spina, Jeffrey R.; Russ, Alissa L.

In: The American Journal of Medicine, Vol. 128, No. 10, 01.10.2015, p. 1117-1125.

Research output: Contribution to journalArticle

Melton, BL, Zillich, AJ, Russell, SA, Weiner, M, McManus, MS, Spina, JR & Russ, AL 2015, 'Reducing prescribing errors through creatinine clearance alert redesign', The American Journal of Medicine, vol. 128, no. 10, pp. 1117-1125. https://doi.org/10.1016/j.amjmed.2015.05.033
Melton, Brittany L. ; Zillich, Alan J. ; Russell, Scott A. ; Weiner, Michael ; McManus, M. Sue ; Spina, Jeffrey R. ; Russ, Alissa L. / Reducing prescribing errors through creatinine clearance alert redesign. In: The American Journal of Medicine. 2015 ; Vol. 128, No. 10. pp. 1117-1125.
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