5PSQ-116 Analysing university hospitals’ clinical decision support system alerts for medication ordering process

<h3>Background and Importance</h3> Computerised physician order entry (CPOE) with structured ordering process and clinical decision support (CDS) system is a widely used systemic defence to enhance medication safety in hospitals. However, the implementation of these systems requires major changes to the workflows, which has been associated with an increased risk of prescribing errors. <h3>Aim and Objectives</h3> To describe and analyse the CDS alerts and the responses of the end-users at ordering process for the further development and optimisation. <h3>Material and Methods</h3> This cross-sectional register-based study was targeted to CDS alerts of a university hospital’s inpatient orders in 2022. CDS alerts of inpatient orders were investigated with descriptive quantitative analysis to identify the prevalence of alerts and end-users’ responses to them. The alerts displayed for conservative and operative specialties were analysed separately to identify possible differences. The data were analysed using descriptive statistics with Microsoft Excel. <h3>Results</h3> In 2022 there were altogether 5,342,217 inpatient medication orders. For 16% (n = 874,317) of the orders, CDSS produced a soft-limit pop-up alert and 87% (n = 762,746) of these were overridden without changing the original orders. The alerts for operative and conservative specialties covered almost 57% (n = 495,399/874,317) of all alerts and there were no major differences between the specialties. Interactions caused the majority of alerts and had high override rates (93–94 %). The highest override rate was for alerts regarding potentially inappropriate medications for older adults (Meds75+), and pregnancy and lactation alerts (94–97 %). The alerts related to drug allergies (55–65% overridden) and duplicate orders (69–88 % overridden) had the highest acceptance rates. <h3>Conclusion and Relevance</h3> The high override rates indicate alert fatigue and a need for optimising the CDS’ alerts. Based on the results, pop-up alerts for interactions should be limited only to the most severe interactions. Unnecessary pregnancy and lactation alerts should be filtered. Meds75+ warnings are not meant to be shown as pop-up alerts, and the clinicians should be guided to use the database in other ways. These changes would decrease 30% of the CDSS’ pop-up alerts. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest