{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T21:01:37Z","timestamp":1781816497869,"version":"3.54.5"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Therapeutic duplication, the presence of multiple agents prescribed for the same indication without clarification for when each should be used, can contribute to serious medical errors. Joint Commission standards require that orders contain clarifying information about when each order should be given. In our system, as needed (PRN) acetaminophen and ibuprofen orders are major contributors to therapeutic duplication.<\/jats:p><jats:p>\n          Objective\u2003The objective of this study is to design and evaluate effectiveness of clinical decision support (CDS) to reduce therapeutic duplication with acetaminophen and ibuprofen orders.<\/jats:p><jats:p>\n          Methods\u2003This study was done in a pediatric health system with three freestanding hospitals. We iteratively designed and implemented two CDS strategies aimed at reducing the therapeutic duplication with these agents: (1) interruptive alert prompting clinicians for clarifying PRN comments at order entry and (2) addition of discrete \u201cfirst-line\u201d and \u201csecond-line\u201d PRN reasons to orders. Therapeutic duplications were measured by manual review of orders for 30-day periods before and after each intervention and 6 months later.<\/jats:p><jats:p>\n          Results\u2003Therapeutic duplications decreased from 1,485 in the 30 days prior to the first alert implementation to 818 in the 30 days after but rose back to 1,208 in the 30 days prior to the second intervention. After discrete reasons were added to the order, therapeutic duplication decreased to 336 in the immediate 30 days and 6 months later remained at 277. Alerts firing rates decreased from 76.0 per 1,000 PRN acetaminophen or ibuprofen orders to 42.9 after the second intervention.<\/jats:p><jats:p>\n          Conclusion\u2003Interruptive alerts may reduce therapeutic duplication but are associated with high rates of user frustration and alert fatigue. Leveraging discrete PRN reasons for \u201cfirst line\u201d and \u201csecond line\u201d produced a greater reduction in therapeutic duplication as well as fewer interruptive alerts and less manual entry for providers.<\/jats:p>","DOI":"10.1055\/a-2082-4631","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T23:02:39Z","timestamp":1682636559000},"page":"538-543","source":"Crossref","is-referenced-by-count":11,"title":["Reducing Therapeutic Duplication in Inpatient Medication Orders"],"prefix":"10.1055","volume":"14","author":[{"given":"Thomas","family":"E. Dawson","sequence":"additional","affiliation":[{"name":"Department of Information Systems & Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Beus","sequence":"additional","affiliation":[{"name":"Department of Information Systems & Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States"},{"name":"Department of pediatrics, Emory University, Atlanta, Georgia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"W. Orenstein","sequence":"additional","affiliation":[{"name":"Department of Information Systems & Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States"},{"name":"Department of pediatrics, Emory University, Atlanta, Georgia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwem","family":"Umontuen","sequence":"additional","affiliation":[{"name":"Department of Information Systems & Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denice","family":"McNeill","sequence":"additional","affiliation":[{"name":"Department of Clinical Development & Medical Affairs, PharmaEssentia USA Corporation, Burlington, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swaminathan","family":"Kandaswamy","sequence":"additional","affiliation":[{"name":"Department of pediatrics, Emory University, Atlanta, Georgia, United 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