A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety
Abstract
Objectives To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. Methods PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Results Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert; 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures; neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-conditio…
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Prior studies found that CDS alerts, if addressed properly, were able to improve prescribing behaviors and medication safety.
“Prior studies found that CDS alerts, if addressed properly, were able to improve prescribing behaviors and medication safety4,63 and adherence to clinical guidelines.6,8”
From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [4]
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Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00136 · Cited by 10,349 · see citing works
The Use and Interpretation of Quasi-Experimental Studies in Medical Informatics
Harris, A. D., McGregor, J. C., Perencevich, E. N., Furuno, J. P., Zhu, J., Peterson, D. E., & Finkelstein, J. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1749 · Cited by 1,023 · see citing works
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Scott, I. A., Pillans, P. I., Barras, M., & Morris, C. (2018) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098618784809 · Cited by 114 · see citing works
Chen, J., Cutrona, S. L., Dharod, A., Bunch, S. C., Foley, K. L., Ostasiewski, B., Hale, E. R., Bridges, A., Moses, A., Donny, E. C., et al. (2023) · JMIR Medical Informatics · doi:10.2196/43097 · Cited by 4 · see citing works
“Third, EHRs have been adopted by most US hospitals [47], and EHR-embedded CDS tools are frequently used to support health care quality improvement [1-6].”
BackgroundChen, J., Cutrona, S. L., Dharod, A., Moses, A., Bridges, A., Ostasiewski, B., Foley, K. L., Houston, T. K., iDAPT (Implementation & Informatics Developing Adaptable Processes and Technologies for Cancer Control) Implementation Science Center for Cancer Control, Chen, J., et al. (2025) · JAMIA Open · doi:10.1093/jamiaopen/ooaf050 · Cited by 3 · see citing works
- Authors
- Page, N., Baysari, M. T., & Westbrook, J. I.
- Affiliations
- Macquarie University (AU)
- UNSW Sydney (AU)
- Corresponding author
- Page, N.
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 105
- Pages
- 22-30
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W2617544848
- Cited by
- 129
- References
- 2
- Citations by year
- 2026: 6 · 2025: 19 · 2024: 11 · 2023: 13 · 2022: 26 · 2021: 19 · 2020: 11 · 2019: 13 · 2018: 10 · 2017: 1
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- interruptive alerts, computerized physician order entry, prescriber behavior, patient safety, drug-drug interaction alerts, alarm fatigue, clinical decision support, hospital prescribing
- MeSH terms
- Drug Interactions, Humans, Medication Errors, Physicians, Reminder Systems, Decision Support Systems, Clinical, Medical Order Entry Systems, Clinical Alarms, Patient Safety
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