SAFER - Duplicate Order Checking for High Risk Meds

SAFER CPOE 2.5 recommends: Duplicate order checking occurs for high risk medication, diagnostic tests, and procedure orders (excluding "as needed" [PRN] medications).

CPOE presents a warning for all categories of duplicate orders - many of these are unnecessary warning/stops/clicks for the user/provider leading to alert fatigue.

Based on their recommendations, there is potential for improved safety features and reduced alert fatigue regarding duplicate alerts. Having a discussion with your user groups is a great place to start.

▪ Therapeutic duplication checking that occurs before new medication orders are submitted (e.g., two orders for the same or two different beta-blockers are placed) is carefully implemented and monitored. Note that there are situations where it is clinically indicated to prescribe duplicate therapies. For example, duplicate alerts should NOT fire for an order for an IV bolus, followed by an order for a continuous drip of the same medication.

▪ There are rules to determine how and when diagnostic tests or procedures receive duplicate checking before they are ordered. - I believe there could be improvements in the duplicate checking/notifications for ancillary services.

▪ Duplicate checking does not include PRN (i.e., as needed) medication orders. - currently when duplicate therapy checking is turned on, it does not exclude PRN meds.

▪ PRN orders should not include overlapping criteria (e.g., for pain 1-3, give aspirin AND for pain 2-4, give Vicodin). - we currently manage this through instructions that require the provider to enter the pain scale however there is no monitoring or hard stops.