Feedback and Training to Improve Use of an Electronic Prescribing System: A Randomised Controlled Trial

Abstract

Excessive presentation of alerts in electronic prescribing systems (ePS) results in 'alert fatigue' which reduces alert effectiveness and frustrates users. Previous research at our study site showed high rates of duplication alerts, some of which were the result of doctors not using available short-cut functions in the ePS. This study aimed to improve uptake of short-cut functions and so reduce alert fatigue by trialing two interventions: feedback and training. Fifty doctors were randomised to one of three groups: Control, Feedback or Training. The Feedback group received an individualised feedback report via email and the Training group received brief face-to-face refresher training. Participants partook in informal interviews to discuss the training and the ePS in use. The proportion of orders which triggered a duplication alert was our primary outcome measure. Neither intervention had a significant impact on duplication alert rate (Feedback: 80.8% vs. 77.8% of orders, Training: 77.5% vs. 76.5% of orders; all p>0.05). We identified a number of factors related to the intervention, ePS and prescribing environment that contributed to this result. Rather than focusing on changing prescribing behaviour, we suggest a more effective and appropriate approach is to redesign the ePS so that fewer and more meaningful alerts are presented.

Keywords: Electronic prescribing; alert fatigue; alerts; feedback; training.