Format

Send to

Choose Destination
Appl Clin Inform. 2014 Sep 3;5(3):802-13. doi: 10.4338/ACI-2013-12-RA-0103. eCollection 2014.

Drug interaction alert override rates in the Meaningful Use era: no evidence of progress.

Author information

1
Department of Medicine, University of Washington.
2
Department of Medicine, University of Washington ; Information Technology Services, UW Medicine, University of Washington.

Abstract

BACKGROUND:

Interruptive drug interaction alerts may reduce adverse drug events and are required for Stage I Meaningful Use attestation. For the last decade override rates have been very high. Despite their widespread use in commercial EHR systems, previously described interventions to improve alert frequency and acceptance have not been well studied.

OBJECTIVES:

(1) To measure override rates of inpatient medication alerts within a commercial clinical decision support system, and assess the impact of local customization efforts. (2) To compare override rates between drug-drug interaction and drug-allergy interaction alerts, between attending and resident physicians, and between public and academic hospitals. (3) To measure the correlation between physicians' individual alert quantities and override rates as an indicator of potential alert fatigue.

METHODS:

We retrospectively analyzed physician responses to drug-drug and drug-allergy interaction alerts, as generated by a common decision support product in a large teaching hospital system.

RESULTS:

(1) Over four days, 461 different physicians entered 18,354 medication orders, resulting in 2,455 visible alerts; 2,280 alerts (93%) were overridden. (2) The drug-drug alert override rate was 95.1%, statistically higher than the rate for drug-allergy alerts (90.9%) (p < 0.001). There was no significant difference in override rates between attendings and residents, or between hospitals. (3) Physicians saw a mean of 1.3 alerts per day, and the number of alerts per physician was not significantly correlated with override rate (R2 = 0.03, p = 0.41).

CONCLUSIONS:

Despite intensive efforts to improve a commercial drug interaction alert system and to reduce alerting, override rates remain as high as reported over a decade ago. Alert fatigue does not seem to contribute. The results suggest the need to fundamentally question the premises of drug interaction alert systems.

KEYWORDS:

Medical order entry systems; clinical decision support systems; drug interactions; medication errors/prevention and control; physician’s practice patterns

PMID:
25298818
PMCID:
PMC4187095
DOI:
10.4338/ACI-2013-12-RA-0103
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Georg Thieme Verlag Stuttgart, New York Icon for PubMed Central
Loading ...
Support Center