M2 Clinical Decision Support Systems Discussion

One of the main benefits of electronic health records (EHRs) is clinical decision support (CDS). CDS provides alerts to inform decision makers at the point of their decisions. CDS alerts can also be used to support organizational policy. For example, the organization might encourage the use of generic drugs.

Describe a specific CDS alert. It can be an alert you have experienced when working with an EHR, or an alert from the literature. Include the triggers that cause the alert to fire, the timing of the alert delivery, and indicate whether the alert supports organizational policy or provides clinical information.

For this discussion:

Initial post: 450-500 words
References required: 2 peer-reviewed or scholarly sources not used in the course

ANSWER

Drug Allergy Alerts

Clinical decision support (CDS) systems focus on improving healthcare delivery by enhancing medical decisions with patient information and targeted clinical knowledge. Most healthcare providers focus on CDS systems to boost patient safety and achieve useful requirements. Electronic health records (EHR) with computerized order entry systems offer clinicians real-time support and guidance during prescribing (Payne et al., 2015). These systems have been indicated to boost the patient care quality and improve safety by reducing patient harm and medication errors. Computerized alerts have prompted the clinicians about drug-disease, drug-drug, and drug-allergy warnings, which offer dosing guidance.

Drug allergy alerts have offered clinical decision support by preventing potential medication errors and adverse consequences (Topaz et al., 2017). Considerably, prescribing medication offers an opportunity for effective and appropriate treatment, but medication errors have been responsible for mortality and morbidity levels. Most medication errors that lead to harm can potentially be avoided through the use of computerized clinical decision supports, especially computerized prompts and alerts. Alerting and reminding offers an important category of offering decision support to the clinicians. For instance, during drug prescription, the drug alerting and drug reminder systems generate information that is used to warn the healthcare provider about the medication errors, drug allergies or support them in making decisions regarding drug prescription.

The drug allergy alerts remind the healthcare provider if the patient has a drug allergy documented in the EHR. The drug allergy interaction alert shows up if the prescribed drug has the potential to interact with the listed allergen in the profile of the patient (Olakotan and Mohd Yusof, 2021). The alert warning lists the reactions that the patient can be exposed to. The three major drug alerts include mild, moderate, and severe. After the drug allergy alert, the physician may decide on overriding the drug-allergy alert. However, they have to offer the reason for overriding, which is included in the prescription data and given to the pharmacists and nurses in the medication procedure as an sign of the healthcare professional’s thoughts during the prescription. Therefore, the drug allergy alerts are prompted by the drug allergy matches on the patient records in the electronic health records system.

The drug allergy interaction database on the electronic health records is structured data that includes drugs and drug groups that cause allergy to the patient (Luri et al., 2021). The electronic health records system reviews all the prescribed drugs against possible allergies. The drug allergy alerts are then prompted if the recommended medication matches the drug allergy information as either probable match, definite match, or possible match. Definite match means the exact match between the prescribed medication and allergen, and a probable match is if the prescribed drug relates to the allergen group of the allergen documented and the probable match is the cross-sensitivity group of the medication ingredient matches the patient’s allergen (Topaz et al., 2016).

Drug allergy alerts offer clinical information that can be used by healthcare professionals to make informed decisions about a patient’s drug prescription (Légat et al., 2018). This is because the computerized alerts offer dosing guidance and information about pairs of drugs that may potentially interact harmfully. For instance, healthcare providers can use the clinical information offered during drug prescription to facilitate medication error management and improve patient safety. Relatively, organizations have medication and drug safety policies that are supported by drug alerts. The alerting systems offer visible notification of probable medication errors during the order entry process with the objective of averting severe prescribing errors.

References

Légat, L., Van Laere, S., Nyssen, M., Steurbaut, S., Dupont, A. G., & Cornu, P. (2018). Clinical decision support systems for drug allergy checking: a systematic review. Journal of medical Internet research, 20(9), e8206.

Luri, M., Leache, L., Gastaminza, G., Idoate, A., & Ortega, A. (2021). A systematic review of drug allergy alert system. International journal of medical informatics, 104673.

Olakotan, O. O., & Mohd Yusof, M. (2021). The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review. Health Informatics Journal, 27(2), 14604582211007536.

Payne, T. H., Hines, L. E., Chan, R. C., Hartman, S., Kapusnik-Uner, J., Russ, A. L., … & Malone, D. C. (2015). Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. Journal of the American Medical Informatics Association, 22(6), 1243-1250.

Topaz, M., Goss, F., Blumenthal, K., Lai, K., Seger, D. L., Slight, S. P., … & Zhou, L. (2017). Towards improved drug allergy alerts: Multidisciplinary expert recommendations. International journal of medical informatics, 97, 353.

Topaz, M., Seger, D. L., Slight, S. P., Goss, F., Lai, K., Wickner, P. G., … & Zhou, L. (2016). Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience. Journal of the American Medical Informatics Association, 23(3), 601-608.