Table 1 Characteristics of studies and alerts included in the systematic review
Study | Study type | Intervention | Setting* | Country | Outcomes measured | Alert functionality** | Improved primary outcome (Yes/No) | False positive alerts reported*** (Yes/No) | Note |
|---|---|---|---|---|---|---|---|---|---|
Bhardwaja et al. 2010 [33] | RCT | Drug-lab alert (Renal) | HMO | US | Proportion of medication errors in drug selection or dosing of targeted drugs | Medication decision guide printed in lieu of the prescription label. | Yes | Yes | Pharmacists were trained to ensure effective communication of the reason for alerts and the rationale for drug changes to prescribers and patients. All activities were documented electronically. |
Raebel et al. 2007 [34] | RCT | Drug-pregnancy alert | HMO | US | Primary - proportion of pregnant women dispensed a FDA category D or X medication. Secondary - total number of first dispensing of targeted medications | Prescription label not printed until pharmacist intervened. | Yes | Yes | False positive alerts led to early cancellation of study. Specific intervention guideline and patient counselling script were developed. |
Raebel et al. 2007 [20] | RCT | Drug-age alert | HMO | US | Proportion of first dispensing of medications on the targeted medication list | Prescription label not printed until pharmacist intervened. | Yes | Yes | Intervention guideline and patient counselling script were developed. Pharmacists were required to complete an intervention note in the system before being able to print the prescription label. Notes were reviewed retrospectively. |
Humphries et al. 2007 [21] | Before-After study (no control) | Drug interaction alert (Contraindicated) | HMO | US | Proportion of patients co-dispensed two critically interacting drugs | Prescription label not printed, pharmacist must consult with the prescriber. | Yes | … | Pharmacists could bypass the alert. They documented their activities electronically. Decision support guide was developed to aid them in interpreting and resolving critical alerts. Scripted conversations were used to explain to patients the reason for alerts and the rationale for medication changes. |
Mansour et al. 2010 [14] | Before-After study (no control) | Drug-lab alert | Large teaching hospital (504-bed) | US | Proportion of hospitalised patients requiring treatment for hyperkalaemia | Pop-up alert about patient’s last reported potassium level | Yes | … | Pharmacists documented their response to the alert electronically. They could override the alert but were required to provide a reason for doing so. Number of alerts was retrieved through a report generated by the information technology pharmacist. Inconsistent response to the alert led to the development of the hyperkalaemia treatment guideline. |