Interpreting nurses' responses to clinical documentation alerts

Abstract

Objective: To understand how nurses respond to alerts that detect attempts to enter into electronic health records patient weights that vary significantly from previously recorded weights.

Methods: Examination of subsequent patient weights to determine if the alerts were true positive (TP) or false positive (FP), and whether nurses overrode alerts, changed their entry or quit without storing a value.

Results: Alerts occurred 2.74%, with 41.9% TP and 58.1% FP. Nurses overrode 30.3% of TP and 97.3% of FP alerts.

Conclusions: The alert has an acceptable FP rate and does not appear to cause nurses to change entries to satisfy the alert. The alert improves recording of patient weights.

Figure 1:

Nurse responses to True Positive (TP) and False Positive (FP) alerts. Note that TP alerts that were changed or quit represent reductions in storage of deviant values. FP alerts that were overridden represent deviant values that were stored despite the alerts.