A look at DUR alerts-why they started, where they are now, and where they need to go.
Clinical decision support (CDS) tools have not reached their full potential, and they need significant improvements to achieve a more efficient DUR alerting system, says Michael Rupp, PhD, Professor of Pharmacy Administration, Midwestern University, Glendale, AZ.
“Prospective DUR is the single most important contemporary clinical role that pharmacists have,” said Rupp, because ensuring patient safety “has to be job one” for the pharmacist, Rupp asserts.
“There is no more important contemporary clinical role of the pharmacist in any practice setting than reviewing prescribed drug therapy prior to dispensing to ensure that at the very least it doesn’t harm the patient,” Rupp told Drug Topics.
When the DUR provisions of the Omnibus Budget Reconciliation Act of 1990 (OBRA 90) legislation were implemented in January of 1993, Rupp said that they legally codified the pharmacist’s responsibilities.
OBRA 90 stimulated a growth in development and use of CDS tools.
In the article,Improving Clinical Decision Support in Pharmacy: Toward the Perfect DUR Alert, in the January 2017 edition Journal of Managed Care and Specialty Pharmacy, Rupp and his co-author, Jenna Reynolds, BS, BA, looked back at the progress made in the 25 years since the implementation of OBRA 90. The intent was to see how much better the DUR systems are now in terms of supporting pharmacists in this critical clinical role.
“I was not surprised, but I was somewhat disappointed to find that most of the problems we had 20 years ago with these systems still exist. And it puts practicing pharmacists in a very difficult position, not having better computer DUR systems to support them in their clinical decisions with respect to this critically important role,” said Rupp.
One of the biggest concerns regarding these systems has to do with alert fatigue.
And it’s not just pharmacists who suffer from this fatigue, said Rupp. “These automated system alerts are now being pushed out to prescribers at the point of care and now they are demonstrating the same response.”
Up next: Suggestions to improve DUR alerts
Rupp suggests a series of recommendations designed to improve DUR alerts:
Joe Moose, PharmD, owner of Moose Pharmacy in Concord, NC, agrees that improvements need to be made to DUR alerts.
This is true,“especially with alert fatigue, which can lead to routine override of alerts without specific detailed information regarding the reasoning behind the override. In some cases, important alerts may be overlooked as irrelevant ones,” Moose said.
Recommendation list reproduced with permission from the Journal of Managed Care and Specialty Pharmacy