So-called “nuisance alerts” generated automatically by electronic medical records (EMRs) are actually more than just a nuisance. Studies indicate that most alerts are ignored due to the frequency of “false alarms.” This can compromise patient safety if a truly important alert is ignored due to “alert fatigue.”
Medication Management Alerts is the newest enhancement to the Great Lakes Integrated Medical Record (GLIMR) currently in use across the Kaleida Health system and designed to become the EMR for all of Great Lakes Health in the next few years. The Medication Management Alerts solution goes live on April 23, 2019.
It identifies nuisance alerts that are appropriate to remove from a clinicians’ view, which means that only the most meaningful alerts will to continue to show, eliminating distractions and adding to the efficient use of GLIMR. The GLIMR project’s clinical advisors and Cerner consultants met with providers and pharmacists to identify alerts that could be suppressed without affecting patient safety.
According to Rachel Hagemann, RPh, lead learning facilitator for Cerner, there are multiple reasons why EMRs are prone to sending nuisance alerts. These include the conservative nature of content produced by commercial vendors and a lack of context from failing to consider the available data, objectives, role and venue of care.
“The approach to reducing nuisance alerts has been to reduce the noise, not to make them more meaningful,” she said. “Cerner solutions no longer filter medication alerts that are a nuisance, but create meaningful alerts that enhance safety and improve patient care.” The solution to nuisance alerts, then, is not just turning alerts off but also making the alerts that stay active smarter and more relevant to each patient and his or her circumstances.
The Medication Management Alerts solution suppresses only the alerts listed here. Alerts that are not on this list will continue to fire without change.
Order detail filtering based on analgesic prn reasons
Suppress duplicate therapy alerts during ordering and verification for acetaminophen, narcotic analgesics, narcotic analgesic combinations or NSAIDs if the PRN pain reason differs.
Order detail filtering based on steroid routes reasons
Suppress duplicate therapy alerts during ordering and verification for glucocorticoids, bronchodilator combinations or inhaled corticosteroids when one ordered route is inhalation while the other is oral, IV push, IV piggyback or IV continuous.
Discontinue on scratchpad filtering
If there is an order on the scratchpad that has a status of Cancel, Discontinue, Delete or Void and an interacting order is placed, the mCDS alert will be suppressed.
Suppress duplicate therapy alerts and drug-drug interaction alerts between orders placed within the same PowerPlan. Alerts will not be suppressed between interactions occurring between different PowerPlans or orders existing on the profile outside of a PowerPlan. Only select PowerPlans are included for suppression.
Repeat numbers in duplication therapy
Duplicate therapy alerts for stimulant and hyperosmotic laxatives will be suppressed for the first two orders placed. Once a 3rd stimulant and hyperosmotic laxative is ordered, the user will start seeing the duplicate therapy alerts. No alert will fire in the background with a system suppressed override reason.
Venue of care filtering
Suppression of drug-drug, drug-allergy and duplicate therapy alerts when converting medications between home medications to inpatient orders. Alerts between inpatients orders will continue to display.
Scheduled vs PRN filtering
Suppress duplicate therapy alerts between interacting orders when one has a scheduled frequency and one has a PRN frequency and the medications include: albuterol, ipratropium-albuterol, levalbuterol, fluticasone-salmeterol, budesonide-formoterol, mometasone-formoterol, arformoterol, fluticasone-vilanterol, tiotropium-olodaterol, tiotropium, umeclidinium-vilanterol, salmeterol, or ipratropium.