Selection and use of decision support alerts in electronic medication management systems in Australian hospitals: a survey of implementers

Background: Electronic medication management (EMM) systems provide the capacity to enable and configure front-end clinical decision support (CDS) tools to trigger medication-related prescribing alerts. Aim: The aim of this study was to determine how and why alerts were selected for inclusion in inpatient EMM systems in Australian hospitals. Methods: A semistructured, cross-sectional survey containing multiple-choice questions, scaled responses and open-ended questions was conducted on a purposive sample of key stakeholders from Australian hospitals who had implemented an EMM system. Results: We interviewed fifteen participants, predominantly pharmacists, representing 26 Australian hospitals that had implemented an EMM system. All hospitals had implemented drug–allergy and drug–drug alerting, and 69% (n = 18) had implemented dose range checking alerting. Implementers reported a high level of customisation of the vendor out-of-the box functionality in efforts to improve sensitivity and specificity of alerts and to minimise alert fatigue. For the most frequently implemented alert categories, most respondents reported that they believed there was research evidence to support the benefits of these alerts to improve prescribing behaviours and patient outcomes. Aside from drug–allergy alerts, less than 50% of EMM implementers reported that they thought alerts had improved prescriber behaviour in their hospitals. Few local evaluations of the effects of alerts had been conducted. Conclusion: The results of this survey provide implementers with new insights into the experiences of Australian hospitals to inform the design and implementation of effective medication prescribing alerts. They also highlight the urgent need for robust evaluations of prescribing alerts in Australian healthcare contexts.