+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Impact of implementing alerts about medication black-box warnings in electronic health records



Impact of implementing alerts about medication black-box warnings in electronic health records



Pharmacoepidemiology and Drug Safety 20(2): 192-202



The Food and Drug Administration issues black-box warnings (BBWs) regarding medications with serious risks, yet physician adherence to the warnings is low. We evaluated the impact of delivering BBW-based alerts about drug-drug, drug-disease, and drug-laboratory interactions for prescription medications in outpatients in an electronic health record with clinical decision support. We compared the frequency of non-adherence to all BBWs about drug-drug, drug-disease, and drug-laboratory interactions for 30 drugs/drug classes, and by individual drugs/drug groups with BBWs between the pre- and post-intervention periods. We used multivariate analysis to identify independent risk factors for non-adherence to BBWs. There was a slightly higher frequency of non-adherence to BBWs after the intervention (4.8% vs. 5.1%, p=0.045). In multivariate analyses, after adjustment for patient and provider characteristics and site of care, medications prescribed during the pre-intervention period were less likely to violate BBWs compared to those prescribed during the post-intervention period (OR 0.67, 95% CI, 0.47-0.96). However, black-box warning violations did decrease after the intervention for BBWs about drug-drug interactions (6.1% vs. 1.8%, p<0.0001) and drug-pregnancy interactions (5.1% vs. 3.6%, p=0.01). Ambulatory care computerized order entry with prescribing alerts about BBWs did not improve clinicians' overall adherence to BBWs, though it did improve adherence for specific clinically important subcategories.

(PDF emailed within 0-6 h: $19.90)

Accession: 053718190

Download citation: RISBibTeXText

PMID: 21254291

DOI: 10.1002/pds.2088


Related references

Evaluation of medication alerts in electronic health records for compliance with human factors principles. Journal of the American Medical Informatics Association 21(E2): E332-E340, 2014

Impact of integrating public health clinical decision support alerts into electronic health records on testing for gastrointestinal illness. Journal of Public Health Management and Practice 18(3): 224-227, 2012

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation. Journal of Hospital Administration 7(2): 36-49, 2018

A systematic approach to optimize electronic health record medication alerts in a health system. American Journal of Health-System Pharmacy 76(8): 530-536, 2019

Allergy alerts in electronic health records for hospitalized patients. Annals of Allergy, Asthma and Immunology 109(2): 137-140, 2012

Implementing Black Box Warnings (BBWs) in Health Information Systems: An Organizing Taxonomy Identifying Opportunities and Challenges. Applied Clinical Informatics 3(1): 124-134, 2012

Effect of modifying dose alerts in an electronic health record on frequency of alerts. American Journal of Health-System Pharmacy 76(Suppl._1): S1-S8, 2019

The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network. Annals of the American Thoracic Society 13(10): 1784-1788, 2016

Impact of electronic health record-based alerts on influenza vaccination for children with asthma. Pediatrics 124(1): 159-169, 2009

International efforts in implementing national health information infrastructure and electronic health records. World Hospitals and Health Services 40(1): 33-7, 39-40, 50-2, 2004

Modelling and implementing electronic health records in Denmark. International Journal of Medical Informatics 74(2-4): 213-220, 2005

Modelling and implementing electronic health records in Denmark. Studies in Health Technology and Informatics 95: 245-250, 2003

Implementing electronic health records: 10 factors for success. Healthcare Financial Management 63(1): 50-2, 54, 2009

Implementing electronic health records in the emergency department. Journal of Emergency Medicine 38(2): 257-263, 2008

Variation in high-priority drug-drug interaction alerts across institutions and electronic health records. Journal of the American Medical Informatics Association 24(2): 331-338, 2016