3100 — Getting on Board with Medication Safety: Mind the Gap

Spina J (VA GLA), Glassman P (VA GLA, Sepulveda COE, VA Center for Medication Safety (Hines)), Simon B (VA GLA, Sepulveda COE), Lanto A (VA GLA, Sepulveda COE), Cunningham F (VA Center for Medication Safety (Hines)), Good C (VA Pittsburgh, VA Center for Medication Safety)

Objectives:
A better understanding of provider perceptions of order entry and order checks (drug alerts) in the computerized patient record system (CPRS) may help in improving gaps in implementation of current prescribing safety measures.

Methods:
A cross-sectional national survey of VA physicians in general medicine, medical and surgical specialties, physical medicine and rehabilitation, psychiatry, and neurology. Survey distribution was web- and paper-based. Eligible physicians had VA prescribing privileges and spent at least one half-day per week (on average) providing direct patient care. Response formats consisted of dichotomous or multiple answer options and Likert scales.

Results:
The adjusted response rate was 1543/3584 (43%). Most providers (90%) felt that CPRS order entry, including its order checks, improves prescribing safety. Most respondents (72%) reported that they always or almost always document outside medications in a clinic note, but a minority (44%) reported that they entered outside medications into the non-VA medication list. For serious allergic or adverse drug reactions, a majority of providers (84%) reported either notifying a pharmacist or personally entering the information in the allergies/adverse reactions field in CPRS, however 16% reported that they did neither. In terms of order checks, providers reported seeing a median of 20 alerts/ week, with a median 5% of those alerts leading to a change in the prescribing plan. Overall, 48% of providers described critical drug-drug interaction alerts as very useful, as did 51% regarding drug-allergy alerts; fewer percentages described significant (non-critical) drug-drug interactions (27%) and drug duplication alerts (25%) to be so. Forty-eight percent of respondents stated that poor signal-to-noise ratio greatly or moderately limited the usefulness of drug alerts in their own practice.

Implications:
The vast majority of VA providers report that CPRS order entry and computerized drug alerts improve prescribing safety; however compliance with mechanisms that improve medication safety, including entering outside medications and adverse drug reactions into relevant CPRS fields, could still be improved.

Impacts:
Addressing gaps in providers’ use of available technology, most notably in entering adverse drug reactions and outside medications into relevant CPRS fields, will facilitate relevant drug alert notifications and further medication safety.