Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Nov-Dec;18(6):789-98.
doi: 10.1136/amiajnl-2011-000199. Epub 2011 Aug 11.

Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

Affiliations
Randomized Controlled Trial

Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

Gregory P T Scott et al. J Am Med Inform Assoc. 2011 Nov-Dec.

Abstract

Objective: Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems.

Design: A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task.

Measurements: The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants' preferences for the prescribing alerts and their views on clinical decision support systems.

Results: Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04).

Conclusions: Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Randomization of participants to alert type assignment group.
Figure 2
Figure 2
Prototype e-prescribing system showing modal alert.
Figure 3
Figure 3
Prototype e-prescribing system showing non-modal alert.
Figure 4
Figure 4
Examples of scenarios.
Figure 5
Figure 5
Sequence of possible events and outcomes for each scenario.
Figure 6
Figure 6
Distribution of error frequency according to alert type (randomized set).

Similar articles

Cited by

References

    1. National Patient Safety Agency Patient Safety Incident Reports in the NHS National Reporting and Learning System Quarterly Data Summary—England. Issue 14. 2009. www.nrls.npsa.nhs.uk/resources/collections/quarterly-data-summaries/?ent... (accessed Oct 2010).
    1. Barber N, Rawlins M, Franklin BD. Reducing prescribing error: competence, control, and culture. Qual Saf Health Care 2003;12:29–32 - PMC - PubMed
    1. Ashcroft D, Heathfield H, Lewis P. An in Depth Investigation into Causes of Prescribing Errors by Foundation Trainees in Relation to their Medical Education - EQUIP Study. www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.... (accessed Oct 2010).
    1. Sanders J, Esmail A. The frequency and nature of medical error in primary care: understanding the diversity across studies. Fam Pract 2003;20:231–6 - PubMed
    1. Smith J. Building a Safer National Health System for Patients: Improving Medication Safety. Department of Health, 2004. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPoli... (accessed Oct 2010).

Publication types

MeSH terms