Prescribers' Responses to Alerts During Medication Ordering in the Long Term Care Setting

The objective of this study was to examine opportunities for improving medication safety in the long-term clinical care setting by determining medication orders that would generate a warning message to the prescriber via a computerized clinical decision support system (CDSS) and assessing which alerts would affect prescribers' actions. For this randomized controlled trial, prescribers ordering drugs for residents on three resident-care units of the facility were presented with alerts; these alerts were not displayed to prescribers in the four control units. During the 12 months of the study, the alert categories most often triggered were related to risks of central nervous system side-effects, such as over-sedation (20%). Alerts for risk of drug-associated constipation (13%) or renal insufficiency/electrolyte imbalance (12%) were also common. Overall, prescribers who received alerts were only slightly more likely to take an appropriate action (relative risk 1.11, 95% confidence interval 1.00, 1.22).  Long-term care facilities must implement new system-level approaches with the potential to improve medication safety for their residents.