Improving Safety By Computerizing Outpatient Prescribing

Study Overview
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Brief Summary
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Patient safety is at the forefront of critical issues in health care. Medications are the single most frequent cause of adverse events, and in the inpatient setting adverse drug events (ADEs) are common, expensive, injurious to patients, and often preventable. Relatively little, however, is known about the frequency of ADEs in the ambulatory setting, how to monitor for outpatient ADEs, or on the impact of prevention strategies such as computerization of prescribing supplemented by decision-support.

Detailed Description
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Specific Aim 1: Increase routine identification of outpatient adverse drug events (ADEs) through development of a computerized ADE detection monitor. Specific Aim 2: Use basic computerized outpatient prescribing to reduce preventable ADEs in a diverse array of outpatient settings. Specific Aim 3: Use advanced decision-support within computerized prescribing to reduce the frequency of preventable ADEs, medication errors, and potential ADEs.

Official Title
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Improving Safety By Computerizing Outpatient Prescribing

Conditions
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Impact of Electronic Prescribing on Medication Safety

Intervention / Treatment
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* Other: Adverse Drug Event Monitoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At Brigham & Women's Hospital, clinics utilizing the electronic medical record will be included. At Regenstrief, any clinic that has access to their electronic medical record will be utilized. For the impact of basic decision support, clinics were not randomized For impact of advanced decision support, clinics were randomized to receive the intervention Exclusion Criteria: Clinics not using electronic medical records

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Adverse Drug Event Monitoring<br>In this intervention arm, clinicians received medication safety alerts when they prescribed medications in the electronic medical record. | Other: Adverse Drug Event Monitoring<br>* The intervention in this study is the presentation of medication safety alerts in the electronic medical record to improve patient outcomes and safety.<br>|
| No Intervention: Care as Usual<br>In this arm, clinicians did not receive the medication safety alerts. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preventable Adverse drug events | Data were electronically collected each time a physician entered a prescription that triggered an alert related to medication safety. | 8/5/2004 - 1/5/2005 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total adverse drug events, medication errors |  | 1/15/2001 - 5/15/2001 |