Table 2 List of extracted context factors including definition and one example for each factor
From: Development of a context model to prioritize drug safety alerts in CPOE systems
| Â | Definition | Example |
|---|---|---|
| Â | ADE rate of the department/hospital The total number of ADEs which occur in the department/hospital. | If a department/hospital has a low rate of a specific ADE, don't show the corresponding alerts. |
| Â | Population of the hospital The epidemiological characteristics of the patient population from the geographical catchment area of the hospital. | Show more alerts for increased risk of liver destruction when the prevalence for liver diseases is high in the area of the hospital. |
| Â | Professional experience of the user Years of working experience; degree and the position in the hierarchy. | A senior physician receives fewer alerts than a resident. |
| Â | Repetition of alerts The number of times a specific alert is presented to the user. | An alert is only shown to a doctor once a day or an alert is never shown twice for the same patient (e.g. after renewal of a prescription). |
Organizational unit | Current task of the user The current step in the medication workflow (prescription, dispensation, administration). | Show all alerts during prescription, but only the most severe alerts during administration. |
| Â | Personal preferences of the user Individual customization of the alerts depending on the user's needs or preferences. | A doctor can turn off certain alerts if he or she doesn't want them. |
| Â | Override-rate of alerts The frequency a specific alert gets overridden by a specific user or department-/hospital-wide. | An alert won't be shown again to a doctor if he/she has already overridden it several times. |
| Â | Specialty The specialist field of the user or the special field of the department/hospital. | A psychiatrist receives different alerts than a surgeon. |
| Â | Workload The number of patients to care for, the staffing of the department, the duration of the shift or the time of the day. | Certain alerts that might be overlooked should be highlighted when the doctor is working for more than 8 h. |
| Â | Demographic data of the patient The sex, age and ethnicity of the patient. | Show certain alerts only for patients older than 60 years. |
Patient/Case | Risk factors of the patient A certain genetic disposition, alcoholism, obesity or under-nutrition. | Show specific alerts only for alcoholics. |
| Â | Tolerance of the drug The case history of the patient shows that he/she tolerates a drug. | Don't show alerts for the possible side effects of aspirin, if the patient hasn't developed any of these in a previous case. |
| Â | Complexity of the case The number of clinical conditions and multi-morbidities of a patient or the number of applied drugs. | Certain alerts that might be overlooked should be highlighted in case that the patient has more than 5 chronic clinical conditions or if he takes more than 5 different drugs at the same time. |
| Â | Clinical status of the patient The type of disease, the severity or stadium of the disease or clinical parameters (e.g. lab values). | Show specific alerts only if the patient suffers from renal diseases or when a lab value reaches a critical threshold. |
| Â | Class of drug The group of the prescribed drug (e.g. narcotics, anticoagulants) relating to the possible damage it may cause. | Highlight specific alerts only for classes of drugs with a high ADE potential (e.g. corticosteroids). |
Alert | Severity of the effect The seriousness of the potential effect. | Don't show alerts when the expected effect may cause no or only minor patient harm. |
| Â | Probability of occurrence The probability of occurrence of the expected ADE. | When prescribing an anticoagulant, show an alert only if the probability of internal bleeding is higher than 5%. |
| Â | Strength of evidence The strength of the scientific evidence of a certain effect. | Don't show alerts if only one non-randomized study reports this certain effect. |
| Â | Topicality of the alert How long a certain alert is in the system or the time since the last update of an alert. | Highlight alerts that are new in the system. |
| Â | Type of alert The type of drug interaction (e.g. drug-drug interaction, drug-allergy interaction) that may occur. | Don't show drug-allergy alerts if allergies are not sufficiently documented in the patient records of the hospital. |