Table 2.

Sample Pharmacy Decision Support Alerts during Study Period

CPOE Order	Context	Alert Triggered
Clinically critical pharmacy alerts
Tylenol #2	Active acetaminophen order	Multiple orders for acetaminophen
Acetazolamide	Allergy order for diamox	Probably allergy to this medication
Amiodarone infusion*	Active digoxin order that preceded amiodarone order	Amiodarone may double serum digoxin concentration/effects
Cost or formulary-related pharmacy alerts
Enoxaparin	Active heparin order	Do not give both heparin and enoxaparin
Verapamil SR	Active order for intravenous Pepcid	If patient can take SR tabs, then why not an oral H2 blocker?
Multivitamin infusion	N/A	There is a nationwide shortage, consider oral dosing
Educational pharmacy alerts
Digoxin†	Active amiodarone order that preceded digoxin order	Amiodarone may double serum digoxin concentration/effects
Celecoxib/Celebrex	N/A	Celecoxib is for arthritis; citalopram is for depression
Abciximab infusion	N/A	For Reopro dosing information, click on this message

CPOE = care provider order entry; SR = sustained release; N/A = not available.

^*Initiating amiodarone in a patient receiving a previously stable digoxin dose can substantially increase digoxin levels and therefore requires an action, such as monitoring digoxin levels or altering the dose of one of the medications. This was categorized as a clinically critical alert.

^†Initiating digoxin in a patient already taking amiodarone will still require a digoxin loading dose and subsequent titration of digoxin until its desired effect is achieved; in this context, the warning about lowering the ultimate digoxin dose is classified as educational since no immediate action is required on starting digoxin.