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Using Human Factors to Design and Implement Visual Medication Safety Alerts in Electronic Medical Records

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Title: Using Human Factors to Design and Implement Visual Medication Safety Alerts in Electronic Medical Records


1
Using Human Factors to Design and Implement
Visual Medication Safety Alerts in Electronic
Medical Records
Barbara Duffy Health Care Informatics and
Technology DHS 8800 Fall 2010
2
Purpose of Medication Alerts for Healthcare
Professionals
  • Warn healthcare staff about potential errors.
  • Enable and support better therapeutic decisions.
  • Warn when interacting drugs are prescribed.
  • Warn when maximum dosage of a drug is exceeded.
  • Prevent dangerous adverse drug events.
  • Warn of drug-drug interactions, therapeutic
    duplication and allergy.
  • To serve as a safety net for providers.
  • A review of human factors principles, 2010.

3
About Medication Alerts
  • There is a lack of acceptance of alerts in
    clinical information systems.
  • Physicians override between 49 and 96 of
    medication alerts.
  • There is a lack of systematic standardization of
    medication alerts.
  • The most significant contributor to overrides are
    too many low priority alerts.
  • Little research has focused on how alerts are
    communicated to the user.
  • A review of human factors principles, 2010 Drug
    safety alert, 2009 Overriding of drug safety
    alerts, 2006.

4
Examples of Medication Alerts
  • Alerts must be specific for the user.
  • For example Alerts for community pharmacists may
    include interaction, contraindication, drug
    duplication, unclear prescription, questionable
    strength, dosage different from previous
    prescription, drug dispensed for the first time,
    incorrect patient data, unusual quantity,
    allergy.
  • A review of human factors principles, 2010.

5
Alert Fatigue
  • Excessive alerts can result in overriding
    recommendations without thought.
  • Reduce the number of alerts that are not useful
    to the user.
  • Incorporate human factors principles into alert
    design to optimize presentation and minimize
    alert fatigue.
  • Socio-technical aspect consider human
    interaction between the user and technology.
  • A review of human factors principles, 2010
    Understanding handling of drug safety alerts,
    2010.

6
About Human Factors
  • Human Factors is the scientific discipline
    concerned with the understanding of interactions
    among humans and other elements of a system, and
    the profession that applies theory, principles,
    data, and other methods to design in order to
    optimize human well-being and overall system
    performance. Human Factors and Ergonomics
    Society, n.d.
  • A review of medical informatics literature found
    basic human factors principles are
    often not utilized. A review of human factors
    principles, 2010.

7
Goals of Integrating Human Factors into
Medication Alerts
  • Improve task performance and patient safety
    through improved alert design and implementation
    parameters.
  • Reduce alert overrides and alert fatigue.
  • Align alerts to fire within workflow processes to
    increase effectiveness.
  • Consistent unique alerting practice -
    categories, priorities, placement, colors,
    shapes, verbiage, exposure, etc. Research-based
    guidelines, 2002 A review of human factors
    principles, 2010.

8
Visibility of the Alert
  • Place alerts within the visual field of the user
    and in order of importance
  • Highest priority alerts toward the center of
    screen that does not require eye movement.
  • Lower priority alerts in fields detected with eye
    movement (30 to 80 horizontal viewing angle).
  • Place alerts in close proximity to the controls
    and displays relevant to the situation being
    indicated.
  • Research-based guidelines, 2002 A review of
    human factors principles, 2010.

9
Visibility of the Alert
  • The alert must be legible and bright.
  • Consider size, background contrast, lettering
    characteristics, content, viewing distance, and
    length of exposure time.
  • Position alert to avoid glare and reflection.
  • Use mixture of upper and lowercase letters.
  • Dark text on a light background is easier to
    read.
  • Research-based guidelines, 2002 A review of
    human factors principles, 2010.

10
Prioritization
  • Red and orange backgrounds are associated with
    increased hazard and priority.
  • Standardized signal words enhance users ability
    to distinguish between severity of priority
    alerts. Such as Danger, Warning, and
    Information.
  • Place signal words at top of alert.
  • Use angular and unstable shapes to indicate
    higher priority and regular shapes indicate lower
    priority.
  • Consider colorblind users.
  • Research-based guidelines, 2002 A review of
    human factors principles, 2010.

11
Information Within the Alert
  • When possible the alert should include
  • Signal word indicating priority (Danger, Warning,
    Information) with statement of nature of hazard.
  • Instruction how to avoid the danger.
  • Consequence of what may happen if information is
    ignored.
  • Also - Present the text in the order of required
    action. Use bullets instead of continuous text.
    Validate for clarity and comprehension with the
    intended user population.
  • Research-based guidelines, 2002 A review of
    human factors principles, 2010.

12
Timing of Alerts
  • Type of alert should determine timing of its
    appearance in the workflow. For example
    drug/drug interaction or allergy alert is fired
    as soon as the physician indicates the name of
    the new medication to be administered.
  • An alert fires to remind the physician to order
    lab work after ordering anticoagulants.
  • A review of human factors principles, 2010.

13
Low Priority Alerts
  • While more alerts seem safer, alert fatigue shows
    the opposite to be true.
  • As low priority alerts are often overridden,
    consider eliminating them. Perhaps assign to
    Information category.
  • Remove alerts that contain no useful information
    for user.
  • Alerts can be too sensitive and fire before
    meaningful safety threshold is exceeded or
    because data is incorrect or out of date.
  • Cause increased workload, distraction, and lower
    performance.
  • Characteristics and consequences of drug allergy
    alert overrides, 2004.

14
More Recommendations
  • Alerts tailored to the user are less irritating
    and less prone to error or override.
  • Auditory alerts may be valuable in special
    circumstances and should be considered in
    combination with some visual alerts.
  • Provide training collect data on alert
    effectiveness.
  • Use color backgrounds to indicate priority.
  • Understanding handling of drug safety alerts,
    2010 Overriding if drug safety alerts, 2006
    Characteristics and consequences of drug allergy
    alert overrides, 2004.

Danger
Warning
15
REFERENCES
  • About HFES. (n.d.). Human Factors and Ergonomics
    Society. Retrieved from http//www.hfes.org
    /web/AboutHFES/about.html
  • Hsiech, T. C., Kuperman, G.J.,Jaggi, T.,
    Hojnoski-Diaz, P., Fiskio, J., Williams, D.H.,
    Bates, D.W., Gandhi, T.K. (2004, November
    - December). Characteristics and consequences of
    drug alert overrides in a computerized physician
    order entry system. Journal of American Medical
    Informatics Association, 11(6), 482-491.
  • Phansalkarl, S., Edworthy, J., Hellier, E.,
    Seger, D.L., Schedlbauer, A., Avery, A.J.,
    Bates, D.W. (2010). A review of human factors
    principles for the design and implementation of
    medication safety alerts in clinical information
    systems. Journal of American Medical Informatics
    Association, 17, 493-501.
  • Van derSijs, H., Aats, J., Berg, M. (2006,
    March April). Overriding of drug safety alerts
    in computerized physician order entry. Journal of
    American Medical Informatics Association, 13(12),
    138-147.
  • Van derSijs, H., van Gelder, T., Vulto, A., Berg,
    M., Aats, J. (2010, May). Understanding
    handling of drug safety alerts a simulation
    study. International Journal of Medical
    Informatics, 79(5), 361-369.
  • Wogalter,M.S., Conzola, V.C., Smith-Jackson,
    T.L. (2002). Research-based guidelines for
    warning design and evaluation. Applied
    Ergonomics, 33, 219-230.
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