Creating Meaningful Alerts and Reducing Alert Fatigue: Strategies Implemented by Informatics Pharmacists to Optimize Dose Range Checking Alerts in a Multihospital Health System

Background: Among the many clinical decision support (CDS) mechanisms available in electronic health record (EHR) systems, dose range checking (DRC) is one of the most impactful safeguard tools integrated within most computerized provider order entry (CPOE) workflows. Unfortunately, improper configurations and lack of resources to maintain and monitor CDS systems can hinder and even disrupt daily clinical operations. Objective: This article seeks to highlight the impact that informatics pharmacists can make by implementing different strategies to decrease nuisance alerts and create clinically meaningful DRC alerts that guide clinicians in their practice. Methods: Following the activation of the DRC application for 3623 medication groupers (ie, generic drugs and all their dosage form variations), informatics pharmacists implemented strategies to monitor DRC alert output and decrease the number of inappropriate alerts. Such strategies included weekly monitoring of alerts, modification of order sentences (including dose, route, and age/weight filters), update to the rule triggering the alerts, and modifications of the preference settings. Results: From July to September 2018, an average of 70 DRC tables were reviewed by informatics pharmacists, reducing the number of overridden DRC alerts to 4796 in the first week of September—a 63% decrease in a 3-month period. Conclusions: By reducing the number of DRC nuisance alerts and improving the clinical content of DRC alerts, informatics pharmacists can contribute to lowering alert fatigue and improving providers’ trust in CDS alerts.