Designing and Integrating a Tired Drug Safety Alert System into Electronic Medication Prescribing Workflow: A Scenario-Simulation Study

Designing and Integrating a Tired Drug Safety Alert System into Electronic Medication Prescribing Workflow: A Scenario-Simulation Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Designing and Integrating a Tired Drug Safety Alert System into Electronic Medication Prescribing Workflow: A Scenario-Simulation Study Hamza Alhamwi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9657120/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Medication prescribing and dispensing clinical decision support systems (CDSS) integrated within electronic physician ordering platforms aim to minimize preventable adverse drug reactions; however, the currently applied systems have limited effectiveness due to alert fatigue and high override rates. Objective To design an assessment of a sequential, workflow-embedded drug safety cautionary system incorporating the medical justification of physicians and pharmacists' validation, with emphasis on clinical relevance and the feasibility of implementation. Methods A specific programmed rule alert system was developed for integration into the system of electronic prescribing. Alerts were initiated during order entry before prescription finalization. Physicians are enabling to override alerts with mandatory reasoning. Alerts and overriding justifications were subsequently reviewed and verified by clinical and dispensing pharmacists. Seven simulated clinical scenarios were designed for the constructed cases, including drug–drug interactions and renal impairment dosing alerts requiring renal function assessment within 48 hours. Outcomes included clinical relevance scoring, implementation feasibility, and alert burden. Results Technically, all alerts were feasible within standard electronic medical record infrastructures. The demonstration system showed high capability for detecting interactions of clinical significance and renal risks needs attention, while sequential alerting decreased unnecessary interruptions. The scoring for clinical relevance indicates that the majority of triggered alerts were actionable, modifiable and capable of minimizing potential harm. Conclusion A multi-layer, pharmacist-integrated alerting system with compulsory physician justification represents an applicable and clinically valuable approach to improve medication safety while mitigating alert fatigue. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9657120","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":637901316,"identity":"4edaaccb-93e3-4b58-963d-4fec8fc27aec","order_by":0,"name":"Hamza Alhamwi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACAxDB2MDAwCcB5tqAuI0HiNLCBtGSBuaSooXhMJjEq8Wc/XTyh487GOTZpJufbuYpOG+3tv0w0JYam2hcWix7cjcYzjzDYNgmc8zsNo/B7eRtZxKBWo6l5TbgctiB3A3JvG0MjG0SCWa3c4BazA4AtTA2HMat5fzbDYf/tjHYt0mkfwNqOZdsdv4hAS03cjc2M7YxJLZJ5IBsOWBndoOQLTfebmbsbZNIBmopu/3HIDnB7AbQlgR8fjmfu/nDzzYb236J9G03Z/yxszc7n/7wwYcaG5xaoEACzkoEq0zArxwV2JOieBSMglEwCkYGAADBdma35S9a0gAAAABJRU5ErkJggg==","orcid":"","institution":"Amman Arab University","correspondingAuthor":true,"prefix":"","firstName":"Hamza","middleName":"","lastName":"Alhamwi","suffix":""}],"badges":[],"createdAt":"2026-05-08 18:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9657120/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9657120/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109419807,"identity":"b31cb4a5-08bc-42b3-8735-cb9128ab6b06","added_by":"auto","created_at":"2026-05-17 21:39:14","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":647058,"visible":true,"origin":"","legend":"","description":"","filename":"designAlertsystem.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9657120/v1_covered_af761568-800a-4103-a1ef-e4c0d98eb16c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDesigning and Integrating a Tired Drug Safety Alert System into Electronic Medication Prescribing Workflow: A Scenario-Simulation Study\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9657120/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9657120/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedication prescribing and dispensing clinical decision support systems (CDSS) integrated within electronic physician ordering platforms aim to minimize preventable adverse drug reactions; however, the currently applied systems have limited effectiveness due to alert fatigue and high override rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo design an assessment of a sequential, workflow-embedded drug safety cautionary system incorporating the medical justification of physicians and pharmacists' validation, with emphasis on clinical relevance and the feasibility of implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA specific programmed rule alert system was developed for integration into the system of electronic prescribing. 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