Dr. Andrew Jones Clinical Director

Managing Alert Fatigue ePrescribing Masterclass WebEx 3rd February 2016, 1-2pm

What is Alert Fatigue? When HCPs become desensitised to safety alerts and as a result ignore or fail to respond appropriately. Major unintended consequence of healthcare computerisation Caused by the sheer number of alerts Compounded by the number of alerts that are clinically inconsequential Made even more bothersome by interrupting the workflow

4 Underlying factors – Components

Underlying factors - PMR Poorly coded entries Free text entries Missing information Absence of contemporaneous coding

Trivial alerts Not evidence based Poorly classified Insufficient patient context Underlying factors – CDS knowledgebase

Underlying Factors – User interface Poor design Overuse of interruptive alerts Lack of Customisation

8 What to do about it?

What to do about it - PMR Make the UI easy to use so that its not a blocker to good contemporaneous clinical coding Facilitate current problem list so that only relevant conditions are used for CDS

What to do about it - CDS Contextualisation: Use simple filters to exclude age or gender specific alerts Use problem list to trigger condition specific alerts Use problem list to suppress unnecessary alerts Use ethnicity to refine alerts

What to do about it - CDS Facilitate local customisation of alerts – One size does not always fit all! Think very carefully about allowing users to turn off alerts

12 An advanced alert engine can address alert fatigue Alerts can be fine-tuned based on the environment and clinical perspective Support efficient workflow with alerts HCPs value Drug Database Advanced Alert Engine Clinical Environment Clinical Evidence Clinical Perspective Relevant Drug Knowledge Customisation of Alerts

Present alerts in manner appropriate to its severity – Only use interruptive alerts for highest severity Utilise pro-active decision support rather than reactive – Present menu of appropriate doses for selection – Limit units of measure to a sensible list – Offer suitable list of routes and suppress any that are dangerous What to do about it - User Interface

fdbhealth.co.uk Dr. Andrew Jones