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Journal Article > Study
Seidling HM, Schmitt SPW, Bruckner T, et al. Qual Saf Health Care. 2010;19:e15.
Clinician decision support systems (CDSS) hold great promise as a means of promoting appropriate care, reducing diagnostic errors, and minimizing medication prescribing errors. However, a recent systematic review found that, taken as a whole, decision support systems achieved only small changes in provider behavior. In this study, a custom-designed CDSS that focused on preventing excessive medication dosages was implemented within a computerized provider order entry system, and resulted in a significant reduction in prescribing errors. Clinicians accepted one in four of the CDSS warnings—a seemingly low proportion that is, in fact, much higher than response rates found in many prior studies of drug alert warnings. The system was carefully tailored to be integrated into provider workflow and to provide only patient-specific warnings, factors that likely contributed to its success.
Journal Article > Review
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
Ratanawongsa N, Chan LLS, Fouts MM, Murphy EJ. J Diabetes Res. 2017;2017:8983237.
Diabetes medications are known to be high risk for adverse drug events. This case study reviews several patient safety measures for electronic prescribing for diabetes in outpatient care. Researchers describe an adverse drug event involving electronic prescribing of insulin and detail how the incident could have been prevented. Electronic prescribing is not currently standardized and may require using a trade name for medications, which may lead to prescribing errors. Adoption of the medication naming conventions put forth by the National Library of Medicine's RxNorm would prevent this vulnerability. Similarly, standardizing electronic prescribing orders for high-risk medications like insulin may reduce the risk of erroneously choosing a long-acting instead of short-acting insulin formulation, which can have life-threatening consequences. The authors advocate for using Universal Medication Schedule instructions and providing language-concordant labels to patients to support safe medication self-administration. They suggest that real-time, bidirectional communication between prescribers and pharmacists may improve safe prescribing. The authors conclude that recommended safety practices are not uniformly implemented in clinical practice and advocate for implementation research to ensure medication safety for outpatients with diabetes.
Journal Article > Commentary
Ho A, Quick O. BMC Med Ethics. 2018;19:18.
Although use of smart technologies for self-diagnosis and care management offers patients convenience, cost-savings, and expediency, they may also contribute to poor decision-making and harm. This commentary explores the impact of direct-to-consumer monitoring devices and smartphone applications on care and the therapeutic relationship. The authors advocate for regulation and assessment regarding accuracy of these tools.