Implementation of medication alert systems and pharmacist satisfaction: a questionnaire-based study

BACKGROUND: As a component of clinical decision support systems, medication alert systems (MAS) play an important role in preventing medication errors. However, their effectiveness is often limited by alert fatigue. Comprehensive data on the implementation and use of specific MAS functions in clinical practice in Japan are limited. Therefore, this study aimed to clarify the implementation of specific MAS functions and identify challenges in real-world use. METHODS: This was a questionnaire-based study conducted among pharmacists at 65 hospitals in Iwate Prefecture, Japan. This questionnaire assessed MAS implementation, functionality, and pharmacists' satisfaction with MAS, while distinguishing between alerts for physicians (primary alerts) and pharmacists (secondary alerts). Satisfaction was assessed using a 7-point Likert scale. Responses were summarized using medians and interquartile ranges (IQR). RESULTS: Of the 65 hospitals, 41 responded to the questionnaire (response rate: 63.1%). 85.4% of hospitals implemented a primary alert system, and 80.5% implemented a secondary alert system. Drug-drug contraindication checks were widely implemented for primary and secondary alerts (91.4% and 97.0%, respectively), whereas variations in the implementation of disease contraindication checks and drug allergy checks were observed between primary and secondary alerts (51.4% vs. 33.3%, and 91.4% vs. 36.4%, respectively). The median overall satisfaction score among pharmacists for secondary alerts was 5 (IQR: 3-5). Lower satisfaction scores were observed for disease contraindication (median: 2; IQR: 1.5-4) and drug allergy checks (median: 2.5; IQR: 2-3.5). Excessive alerts, discrepancies between alert content and clinical judgment, and system-related limitations were the most common reasons for dissatisfaction. CONCLUSIONS: Although MAS were widely implemented, variations in alert functions and their use were observed across hospitals and between physicians and pharmacists. Pharmacists commonly reported excessive alerts, discrepancies between alert results and clinical judgment, and system-related limitations as reasons for dissatisfaction. Lower satisfaction was observed for disease contraindication and drug allergy checks, suggesting that these functions require further improvement. These findings highlight the need to optimize alert settings, improve system integration, and enhance the clinical relevance of alerts. Addressing these challenges may help promote the effective use of MAS and improve medication safety in clinical practice.