EHR Nudges for Prescribing Errors
(SOMNUS Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial explores whether changes to electronic health records (EHR) can reduce the prescription of Z-drugs, commonly used for insomnia. It examines two main strategies: setting a default limit on the number of pills prescribed (Default Intervention) and providing alerts that suggest alternative treatments (Accountable Justification). The trial aims to determine if these nudges, either alone or together, can encourage doctors to prescribe fewer Z-drugs. It is suitable for outpatient primary care clinicians at Northwestern Medicine who haven't participated in related studies and don’t have patients with bipolar disorder in their care list. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could improve prescribing practices and patient care.
Will I have to stop taking my current medications?
The trial does not specify whether participants must stop taking their current medications. It focuses on how electronic health record changes can influence prescribing habits for Z-drugs, not on altering current medication regimens.
What prior data suggests that these EHR nudges are safe for reducing Z-drug prescribing?
Studies have shown that electronic health records (EHRs) can help reduce medication mistakes and make prescribing safer. For example, research suggests that setting default options in EHRs, such as a specific number of pills, can guide doctors in prescribing medications. This approach helps ensure patients receive safer and more suitable prescriptions.
However, EHR systems can still contain errors. Some studies indicate that if not managed carefully, EHRs can sometimes lead to more medication mistakes. Overall, well-designed EHR systems tend to support better prescribing practices.
This trial focuses on using EHR prompts, such as setting default pill amounts and requesting reasons for certain prescriptions. These methods aim to reduce inappropriate prescribing. The trial is labeled "Not Applicable," indicating it does not involve testing a new drug or device. The safety of these EHR methods generally depends on careful use and monitoring.12345Why are researchers excited about this trial?
Researchers are excited about this trial because it explores innovative ways to reduce prescribing errors through electronic health record (EHR) nudges. Unlike traditional methods that rely solely on clinician education, this approach introduces accountability by requiring clinicians to justify guideline-discordant orders, which are then visible to their peers. Additionally, using defaults like a 10-pill quantity for prescriptions aims to subtly guide clinicians towards safer prescribing practices. These strategies hope to enhance patient safety and improve adherence to guidelines, offering a proactive solution to reduce errors that current educational interventions alone might not address.
What evidence suggests that these EHR nudges are effective for reducing Z-drug prescribing in insomnia?
Research has shown that changes to electronic health records (EHRs), such as requiring doctors to explain their prescribing decisions and setting a default number of pills, can reduce prescribing mistakes. In this trial, some clinicians will participate in the "Redirection + Accountable Justification" arm, where they must justify orders that do not align with guidelines, thereby increasing awareness and reducing errors. Others will join the "Z-drug Default Quantity" arm, where a default number of pills is set, providing a clear starting point to minimize mistakes. These methods aim to enhance medication safety without limiting doctors' options. They have succeeded in other areas, suggesting they could also help reduce the prescribing of Z-drugs for insomnia.56789
Who Is on the Research Team?
Jason Doctor, PhD
Principal Investigator
University of Southern California
Are You a Good Fit for This Trial?
This trial is for primary care clinicians. It aims to see if certain changes in the electronic health record system can help them prescribe fewer Z-drugs, which are medications used to treat insomnia.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Educational Module
Clinician-participants complete an introductory educational module about treating insomnia and relevant EHR changes
Intervention
Clinicians experience EHR changes when prescribing Z-drugs, including a Z-drug dispense quantity default of 10 pills for new orders, a prompt to remove or justify Z-drug orders, both, or neither
Follow-up
Participants are monitored for safety and effectiveness after the intervention
What Are the Treatments Tested in This Trial?
Interventions
- Accountable Justification
- Default Intervention
Trial Overview
The study tests two 'nudges' within the EHR: setting a default dispense quantity of 10 pills with no refills for new Z-drug prescriptions, and an alert that prompts clinicians to consider removing a Z-drug or adding behavioral treatment for insomnia.
How Is the Trial Designed?
4
Treatment groups
Experimental Treatment
Active Control
Clinicians randomized to this arm receive guideline education + 10 pill quantity defaults.
Clinicians randomized to this arm receive guideline education + alerts requiring justification of orders discordant with guidelines. Justifications are entered in the patient's medical record, and can be viewed by other clinicians.
Clinicians randomized to this arm receive guideline education + 10 pill quantity defaults + alerts requiring justification of orders discordant with guidelines. Justifications are entered in the patient's medical record, and can be viewed by other clinicians
Clinicians randomized to this arm receive guideline education prior to the trial.
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Southern California
Lead Sponsor
Northwestern Medicine
Collaborator
National Heart, Lung, and Blood Institute (NHLBI)
Collaborator
Published Research Related to This Trial
Citations
Medication Dispensing Errors and Prevention - NCBI - NIH
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