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Medication-related clinical decision support alert overrides in inpatients


Nanji, Karen C; Seger, Diane L; Slight, Sarah P; Amato, Mary G; Beeler, Patrick E; Her, Qoua L; Dalleur, Olivia; Eguale, Tewodros; Wong, Adrian; Silvers, Elizabeth R; Swerdloff, Michael; Hussain, Salman T; Maniam, Nivethietha; Fiskio, Julie M; Dykes, Patricia C; Bates, David W (2018). Medication-related clinical decision support alert overrides in inpatients. Journal of the American Medical Informatics Association (JAMIA), 25(5):476-481.

Abstract

Objective: To define the types and numbers of inpatient clinical decision support alerts, measure the frequency
with which they are overridden, and describe providers’ reasons for overriding them and the appropriateness
of those reasons.
Materials and Methods: We conducted a cross-sectional study of medication-related clinical decision support
alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides,
the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those
reasons.
Results: Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden,
though the rate of overrides varied by alert type (P<.0001). About 60% of overrides were appropriate, and that
proportion also varied by alert type (P<.0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication
substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution
(82.5%) alerts were appropriate.
Discussion: Despite warnings of potential significant harm, certain categories of alert overrides were
inappropriate>75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution
alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to
reduce alert fatigue.
Conclusion: Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate.
Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert
fatigue so that important alerts are not inappropriately overridden.

Abstract

Objective: To define the types and numbers of inpatient clinical decision support alerts, measure the frequency
with which they are overridden, and describe providers’ reasons for overriding them and the appropriateness
of those reasons.
Materials and Methods: We conducted a cross-sectional study of medication-related clinical decision support
alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides,
the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those
reasons.
Results: Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden,
though the rate of overrides varied by alert type (P<.0001). About 60% of overrides were appropriate, and that
proportion also varied by alert type (P<.0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication
substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution
(82.5%) alerts were appropriate.
Discussion: Despite warnings of potential significant harm, certain categories of alert overrides were
inappropriate>75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution
alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to
reduce alert fatigue.
Conclusion: Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate.
Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert
fatigue so that important alerts are not inappropriately overridden.

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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
Uncontrolled Keywords:alert fatigue, computerized physician order entry, electronic health record, meaningful use, patient safety
Language:English
Date:2018
Deposited On:30 Nov 2017 16:47
Last Modified:18 Apr 2018 01:01
Publisher:BMJ Publishing Group
ISSN:1067-5027
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/jamia/ocx115
PubMed ID:29092059

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