Abstract
Objective Alert presentation of clinical decision support recommendations is a common method
for providing information; however, many alerts are overridden suggesting presentation
design improvements can be made. This study attempts to assess pediatric prescriber
information needs for drug–drug interactions (DDIs) alerts and to evaluate the optimal
presentation timing and presentation in the medication ordering process.
Methods Six case scenarios presented interactions between medications used in pediatric specialties
of general medicine, infectious disease, cardiology, and neurology. Timing varied
to include alert interruption at medication selection versus order submission; or
was noninterruptive. Interviews were audiotaped, transcribed, and independently analyzed
to derive central themes.
Results Fourteen trainee and attending clinicians trained in pediatrics, cardiology, and
neurology participated. Coders derived 8 central themes from 929 quotes. Discordance
exists between medication prescribing frequency and DDI knowledge; providers may commonly
prescribe medications for which they do not recognize DDIs. Providers wanted alerts
at medication selection rather than at order signature. Alert presentation themes
included standardizing text, providing interaction-specific incidence/risk information,
DDI rating scales, consolidating alerts, and providing alternative therapies. Providers
want alerts to be actionable, for example, allowing medication discontinuation and
color visual cues for essential information. Despite alert volume, participants did
not “mind being reminded because there is always the chance that at that particular
moment (they) do not remember it” and acknowledged the importance of alerts as “essential
in terms of patient safety.”
Conclusion Clinicians unanimously agreed on the importance of receiving DDI alerts to improve
patient safety. The perceived alert value can be improved by incorporating clinician
preferences for timing and presentation.
Keywords
drug interactions - electronic health records - health personnel alert fatigue - medication
alert systems
