I. Cho
Understanding Physicians' Behavior toward Alerts on Nephrotoxic Medications in Outpatients: A Cross-Sectional Analysis
Cho, I.; Slight, S.P.; Nanji, K.C.; Seger, D.L.; Maniam, N.; Dykes, P.C.; Bates, D.W.
Authors
S.P. Slight
K.C. Nanji
D.L. Seger
N. Maniam
P.C. Dykes
D.W. Bates
Abstract
Background: Although most outpatients are relatively healthy, many have chronic renal insufficiency, and high override rates for suggestions on renal dosing have been observed. To better understand the override of renal dosing alerts in an outpatient setting, we conducted a study to evaluate which patients were more frequently prescribed contraindicated medications, to assess providers' responses to suggestions, and to examine the drugs involved and the reasons for overrides. Methods: We obtained data on renal alert overrides and the coded reasons for overrides cited by providers at the time of prescription from outpatient clinics and ambulatory hospital-based practices at a large academic health care center over a period of 3 years, from January 2009 to December 2011. For detailed chart review, a group of 6 trained clinicians developed the appropriateness criteria with excellent inter-rater reliability (kappa = 0.93). We stratified providers by override frequency and then drew samples from the high- and low-frequency groups. We measured the rate of total overrides, rate of appropriate overrides, medications overridden, and the reason(s) for override. Results: A total of 4120 renal alerts were triggered by 584 prescribers in the study period, among which 78.2% (3,221) were overridden. Almost half of the alerts were triggered by 40 providers and one-third was triggered by high-frequency overriders. The appropriateness rates were fairly similar, at 28.4% and 31.6% for high- and low-frequency overriders, respectively. Metformin, glyburide, hydrochlorothiazide, and nitrofurantoin were the most common drugs overridden. Physicians' appropriateness rates were higher than the rates for nurse practitioners (32.9% vs. 22.1%). Physicians with low frequency override rates had higher levels of appropriateness for metformin than the high frequency overriders (P = 0.005). Conclusion: A small number of providers accounted for a large fraction of overrides, as was the case with a small number of drugs. These data suggest that a focused intervention targeting primarily these providers and medications has the potential to improve medication safety.
Citation
Cho, I., Slight, S., Nanji, K., Seger, D., Maniam, N., Dykes, P., & Bates, D. (2014). Understanding Physicians' Behavior toward Alerts on Nephrotoxic Medications in Outpatients: A Cross-Sectional Analysis. BMC Nephrology, 15, Article 200. https://doi.org/10.1186/1471-2369-15-200
Journal Article Type | Article |
---|---|
Acceptance Date | Dec 11, 2011 |
Publication Date | Dec 15, 2014 |
Deposit Date | Dec 18, 2014 |
Publicly Available Date | Aug 25, 2015 |
Journal | BMC Nephrology |
Publisher | BioMed Central |
Peer Reviewed | Peer Reviewed |
Volume | 15 |
Article Number | 200 |
DOI | https://doi.org/10.1186/1471-2369-15-200 |
Keywords | Medication safety, Clinical decision support system, Renal insufficiency, Drug prescribing, Chronic kidney disease. |
Files
Published Journal Article
(918 Kb)
PDF
Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/
Copyright Statement
© 2014 Cho et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
You might also like
Patients' perceptions and experiences of patient safety in primary care in England
(2016)
Journal Article
Downloadable Citations
About Durham Research Online (DRO)
Administrator e-mail: dro.admin@durham.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search