Header

UZH-Logo

Maintenance Infos

Evaluation of medication-related clinical decision support alert overrides in the intensive care unit


Wong, Adrian; Amato, Mary G; Seger, Diane L; Slight, Sarah P; Beeler, Patrick E; Dykes, Patricia C; Fiskio, Julie M; Silvers, Elizabeth R; Orav, E. John; Eguale, Tewodros; Bates, David W (2017). Evaluation of medication-related clinical decision support alert overrides in the intensive care unit. Journal of Critical Care, 39:156-161.

Abstract

Purpose: Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU.
Materials and methods: We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that re-sulted from the overridden alert.
Results: A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n = 366), with an increased risk of ADEs associated with inappropriately overridden alerts (p = 0.0078). Conclusions: The appropriateness of medication-related clinical decision support overrides in the ICU varied sub-stantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.

Abstract

Purpose: Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU.
Materials and methods: We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that re-sulted from the overridden alert.
Results: A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n = 366), with an increased risk of ADEs associated with inappropriately overridden alerts (p = 0.0078). Conclusions: The appropriateness of medication-related clinical decision support overrides in the ICU varied sub-stantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.

Statistics

Citations

Dimensions.ai Metrics
11 citations in Web of Science®
7 citations in Scopus®
6 citations in Microsoft Academic
Google Scholar™

Altmetrics

Downloads

87 downloads since deposited on 05 Oct 2017
71 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:2017
Deposited On:05 Oct 2017 09:12
Last Modified:24 Sep 2019 22:49
Publisher:Elsevier
ISSN:0883-9441
OA Status:Green
Publisher DOI:https://doi.org/10.1016/j.jcrc.2017.02.027
PubMed ID:28259059

Download

Green Open Access

Download PDF  'Evaluation of medication-related clinical decision support alert overrides in the intensive care unit'.
Preview
Content: Accepted Version
Filetype: PDF
Size: 345kB
View at publisher