Take these steps to reduce alert fatigue
Involve physicians in the development and implementation of alert systems, rather than simply training them in the systems when you're ready to go live, says Linda Peitzman, MD, chief medical officer of Wolters Kluwer Health in Indianapolis.
"Get their input into how and when they want these things to fire, so that when they do fire, they won't be surprised," Peitzman says. "They will understand why they were included, and they will be much more apt to pay attention to them."
With technology growing so rapidly and health care providers wanting to improve safety by standardizing processes, there is a temptation to keep adding more alerts, she says. "There are many other tools you have for clinical decision support [that can be added] into the work flow," Peitzman says. "So, ask whether another alert is the right thing. Maybe we could do an order set that automatically has this in it instead of reminding them. Or when they document it, this action automatically happens instead of reminding them to do it."
When implementing computerized physician order entry (CPOE) or any system with built-in alerts, the threshold for alerts should be turned down, at least initially, to ensure there is buy-in and not a perception that there's interference with the clinical workflow, says Dan O'Keefe, MD, executive vice president for the Society for Maternal-Fetal Medicine, chief medical officer for PeriGen, and an OB/GYN and maternal-fetal medicine expert. O'Keefe offers this further advice:
- Introduction of clinical alarms as a part of any system should be a deliberate and gradual process. Otherwise, a hospital risks alienation of staff, who already are busy and trying to get up to speed on new technology and new behavior.
- Alerts absolutely must be clinically relevant or the doctors and other staff will certainly ignore them.
- The frequency of alerts and the use of hard stops, which prevent doctors from taking any further action, are important. Overuse will only cause frustration and disillusionment with the system. Choose carefully when deciding which interruptive alerts are necessary.
- Alerts should be evaluated by hospital staff on a quarterly basis to make sure they are clinically relevant. If they are not relevant, but simply a nuisance, they may be removed. Conversely, if the alerts are relevant and support the practice of evidence-based medicine, then the hospital must instruct the doctors to comply.
Peitzman agrees that health care providers should monitor the use of alerts within their systems, looking for chances to improve. "You should not only measure how many of them are being acted upon, but you also should talk to your physicians and find out about the effectiveness, the value, the appropriateness, and you can continue to modify them over time," she says.
Also, don't be afraid to disable alerts that came as part of a system package, she says. Ask yourself if this alert is something truly important to your patients or if it will just add to the cacophony of alerts. A warning about dietary restrictions or food interaction might be valid, for instance, but is it important enough to justify an alert screen for the physician? Pare down the alerts to the ones that really matter, and clinicians will pay more attention to them, Peitzman says.