A Trial of Automated Safety Alerts for Inpatient Digoxin Use with Computerized Physician Order Entry
Open accessAbstract
OBJECTIVE: Automated clinical decision support (CDS) has shown promise in improving safe medication use. The authors performed a trial of CDS, given both during computerized physician order entry (CPOE) and in response to new laboratory results, comparing the time courses of clinician behaviors related to digoxin use before and after implementation of the alerts. DESIGN: Alerts were implemented to notify of the potential risk from low electrolyte concentrations or unknown digoxin or electrolyte concentrations during CPOE. Alerts were also generated in response to newly reported hypokalemia and hypomagnesemia in patients given digoxin. MEASUREMENTS: Clinician responses to the alerts for six months were compared with responses to similar situations for six months prior to implementation. RESULTS: During CPOE, checking for unknown serum values increased after implementation compared with control at one hour: 19% vs. 6% for digoxin, 57% vs. 9% for potassium, and 40% vs. 12% for magnesium as well as at 24 hours (p < 0.01 for all comparisons). Electrolyte supplementation increased with newly reported hypokalemia and hypomagnesemia after implementation at one hour: 35% vs. 6% and 49% vs. 5% for potassium and magnesium, respectively, as well as at 24 hours (p < 0.01 for all comparisons). During CPOE, supplementation for hypokalemia was not improved, whereas supplementation for hypomagnesemia improved at one hour (p < 0.05). CONCLUSION: Overall, the alerts improved the safe use of digoxin. During CPOE, alerts associated with missing levels were effective. For hypokalemia and hypomagnesemia, the alerts given during CPOE were not as effective as those given at the time of newly reported low electrolytes.
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CPOE systems prevent some types of errors while creating or propagating new ones.
“CPOE systems prevent some types of errors while creating or propagating new ones.4,5,21,22,24,25,33,54 -61”
From Types of Unintended Consequences Related to Computerized Provider Order Entry (2006) · cites this paper as [33]
The Abstract (page unavailable) says CPOE combined with basic clinical decision support decreases the likelihood of serious medication errors. Neither that passage nor the Discussion (page unavailable) says CPOE creates or propagates new errors; the Discussion addresses alerts that clinicians may ignore, not errors caused by CPOE. (LLM, conf=0.88)
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Cites
Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention
Bates, D. W. (1995) · JAMA · doi:10.1001/jama.1995.03530010043033 · Cited by 2,127 · see citing works
Bates, D. W. (1998) · JAMA · doi:10.1001/jama.280.15.1311 · Cited by 2,107 · see citing works
Medication Errors and Adverse Drug Events in Pediatric Inpatients
Kaushal, R. (2001) · JAMA · doi:10.1001/jama.285.16.2114 · Cited by 1,917 · see citing works
Classen, D. C. (1997) · JAMA · doi:10.1001/jama.277.4.301 · Cited by 1,781 · see citing works
Bates, D. W. (1997) · JAMA · doi:10.1001/jama.277.4.307 · Cited by 1,678 · see citing works
Relationship between medication errors and adverse drug events
Bates, D. W., Boyle, D. L., Vliet, M. B. V., Schneider, J., & Leape, L. (1995) · Journal of General Internal Medicine · doi:10.1007/bf02600255 · Cited by 981 · see citing works
Drug-related morbidity and mortality. A cost-of-illness model
Johnson, J. A. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.155.18.1949 · Cited by 942 · see citing works
Adverse drug events in hospitalized patients
van den Bemt, P. M. L. A., Egberts, T. C. G., Lenderink, A. W., Verzijl, J. M., Simons, K. A., van der Pol, W. S. C. J. M., & Leufkens, H. G. M. (1999) · European Journal of Clinical Pharmacology · doi:10.1007/s002280050611 · Cited by 460 · see citing works
Leape, L. L., Lawthers, A. G., Brennan, T. A., & Johnson, W. G. (1993) · QRB - Quality Review Bulletin · doi:10.1016/s0097-5990(16)30608-x · Cited by 431 · see citing works
A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission
Overhage, J. M., Tierney, W. M., Zhou, X., & McDonald, C. J. (1997) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1997.0040364 · Cited by 375 · see citing works
Incidence and preventability of adverse drug events in hospitalized adults
Bates, D. W., Leape, L. L., & Petrycki, S. (1993) · Journal of General Internal Medicine · doi:10.1007/bf02600138 · Cited by 373 · see citing works
A Computer Alert System to Prevent Injury From Adverse Drug Events
Raschke, R. A., Gollihare, B., Wunderlich, T. A., Guidry, J. R., Leibowitz, A. I., Peirce, J. C., Lemelson, L., Heisler, M. A., & Susong, C. R. (1998) · JAMA · doi:10.1001/jama.280.15.1317 · Cited by 356 · see citing works
Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients
Rind, D. M. (1994) · Archives of Internal Medicine · doi:10.1001/archinte.1994.00420130107014 · Cited by 323 · see citing works
Kuperman, G. J., Teich, J. M., Tanasijevic, M. J., Ma'Luf, N., Rittenberg, E., Jha, A., Fiskio, J., Winkelman, J., & Bates, D. W. (1999) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1999.0060512 · Cited by 252 · see citing works
Recognition and management of digitalis toxicity
Kelly, R. A., & Smith, T. W. (1992) · The American Journal of Cardiology · doi:10.1016/0002-9149(92)91259-7 · Cited by 152 · see citing works
Medication Errors in United States Hospitals
Bond, C., Raehl, C. L., & Franke, T. M. (2001) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.21.13.1023.34617 · Cited by 143 · see citing works
Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter
Roberts, S. A., Diaz, C., Nolan, P. E., Salerno, D. M., Stapczynski, J. S., Zbrozek, A. S., Ritz, E. G., Bauman, J. L., & Vlasses, P. H. (1993) · The American Journal of Cardiology · doi:10.1016/0002-9149(93)90353-e · Cited by 102 · see citing works
Computerized Laboratory Alerting System
Kuperman, G. J., Gardner, R. M., & Pryor, T. A. (1991) · Computers and medicine · doi:10.1007/978-1-4612-3070-0_17 · Cited by 82 · see citing works
Decision support alerts for clinical laboratory and blood gas data
Shabot, M. M., LoBue, M., Leyerle, B. J., et al. (1990) · International journal of clinical monitoring and computing · doi:10.1007/bf02915529 · Cited by 39 · see citing works
Kaushal, R., Shojania, K. G., & Bates, D. W. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.12.1409 · Cited by 30 · see citing works
Economic Impact of Digoxin Toxicity
Gandhi, A. J., Vlasses, P. H., Morton, D. J., & Bauman, J. L. (1997) · PharmacoEconomics · doi:10.2165/00019053-199712020-00007 · Cited by 29 · see citing works
Designing studies of computer-based alerts and reminders.
Dm, R., Davis, R., & Safran, C. (1995) · PubMed · Cited by 25 · see citing works
Adverse drug events in hospitalized patients
Davis, P. T. (1997) · JAMA · doi:10.1001/jama.277.17.1351c · Cited by 19 · see citing works
Preventing exacerbation of an ADE with automated decision support.
Galanter, W., DiDomenico, R. J., & Polikaitis, A. (2002) · PubMed · Cited by 16 · see citing works
Self-citationDecision Support Alerts for Clinical Laboratory and Blood Gas Data
Shabot, M. M., LoBue, M., Leyerle, B. J., et al. (1994) · Computers and medicine · doi:10.1007/978-1-4612-2698-7_11 · Cited by 3 · see citing works
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Types of Unintended Consequences Related to Computerized Provider Order Entry
Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2042 · Cited by 823 · see citing works
Schedlbauer, A., Prasad, V., Mulvaney, C., Phansalkar, S., Stanton, W., Bates, D. W., & Avery, A. J. (2009) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2910 · Cited by 262 · see citing works
A pilot test of a tailored mobile and web-based diabetes messaging system for adolescents
Mulvaney, S. A., Anders, S., Smith, A. K., Pittel, E. J., & Johnson, K. B. (2012) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2011.111006 · Cited by 128 · see citing works
- Authors
- Galanter, W. L.
- Affiliations
- University of Illinois Chicago (US)
- Corresponding author
- Galanter, W. L.
- ORCID
- Galanter, W. L.
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-04-02
- Volume
- 11
- Issue
- 4
- Pages
- 270-277
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC436074
- OpenAlex
- W1847211935
- Cited by
- 53
- References
- 25
- Citations by year
- 2025: 2 · 2024: 1 · 2021: 1 · 2019: 2 · 2018: 1 · 2017: 2 · 2015: 2 · 2013: 2 · 2012: 3
- FWCI
- 16.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (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
- digoxin, automated clinical decision support, computerized physician order entry, safety alerts, hypokalemia, hypomagnesemia, electrolyte supplementation, inpatient medication safety
- MeSH terms
- Anti-Arrhythmia Agents, Digoxin, Drug Therapy, Computer-Assisted, Electrolytes, Hospital Information Systems, Humans, Medical Audit, Medical Staff, Hospital, Medication Errors, Medication Systems, Hospital, Safety, User-Computer Interface, Medical Records Systems, Computerized, Decision Support Systems, Clinical
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