Header

UZH-Logo

Maintenance Infos

Evaluation of Harm Associated with High Dose-Range Clinical Decision Support Overrides in the Intensive Care Unit


Wong, Adrian; Rehr, Christine; Seger, Diane L; Amato, Mary G; Beeler, Patrick E; Slight, Sarah P; Wright, Adam; Bates, David W (2019). Evaluation of Harm Associated with High Dose-Range Clinical Decision Support Overrides in the Intensive Care Unit. Drug Safety, 42(4):573-579.

Abstract

Introduction Medication-related clinical decision support (CDS) alerts have been shown to be effective at reducing adverse drug events (ADEs). However, these alerts are frequently overridden, with limited data linking these overrides to harm. Dose-range checking alerts are a type of CDS alert that could have a significant impact on morbidity and mortality, especially in the intensive care unit (ICU) setting.
Methods We performed a single-center, prospective, observational study of adult ICUs from September 2016 to April 2017. Targeted overridden alerts were triggered when doses greater than or equal to 5% over the maximum dose were prescribed. The primary outcome was the appropriateness of the override determined by two independent reviewers, using pre-specified criteria formulated by a multidisciplinary group. Overrides which resulted in medication administration were then evaluated for ADEs by chart review.
Results The override rate of high dose-range alerts in the ICU was 93.0% (total n=1525) during the study period. A total of 1418 overridden alerts from 755 unique patients were evaluated for appropriateness (appropriateness rate: 88.8%). The most common medication associated with high dose-range alerts was insulin regular infusion (n=262, 18.5%). The rates of ADEs for the appropriately and inappropriately overridden alerts per 100 overridden alerts were 1.3 and 5.0, respectively (p<0.001).
Conclusions Overriding high dose-range CDS alerts was found to be common and often appropriate, suggesting that more intelligent dose-checking is needed. Some alerts were clearly inappropriately presented to the provider. Inappropriate overrides were associated with an increased risk of ADEs, compared to appropriately overridden alerts.

Abstract

Introduction Medication-related clinical decision support (CDS) alerts have been shown to be effective at reducing adverse drug events (ADEs). However, these alerts are frequently overridden, with limited data linking these overrides to harm. Dose-range checking alerts are a type of CDS alert that could have a significant impact on morbidity and mortality, especially in the intensive care unit (ICU) setting.
Methods We performed a single-center, prospective, observational study of adult ICUs from September 2016 to April 2017. Targeted overridden alerts were triggered when doses greater than or equal to 5% over the maximum dose were prescribed. The primary outcome was the appropriateness of the override determined by two independent reviewers, using pre-specified criteria formulated by a multidisciplinary group. Overrides which resulted in medication administration were then evaluated for ADEs by chart review.
Results The override rate of high dose-range alerts in the ICU was 93.0% (total n=1525) during the study period. A total of 1418 overridden alerts from 755 unique patients were evaluated for appropriateness (appropriateness rate: 88.8%). The most common medication associated with high dose-range alerts was insulin regular infusion (n=262, 18.5%). The rates of ADEs for the appropriately and inappropriately overridden alerts per 100 overridden alerts were 1.3 and 5.0, respectively (p<0.001).
Conclusions Overriding high dose-range CDS alerts was found to be common and often appropriate, suggesting that more intelligent dose-checking is needed. Some alerts were clearly inappropriately presented to the provider. Inappropriate overrides were associated with an increased risk of ADEs, compared to appropriately overridden alerts.

Statistics

Citations

Altmetrics

Downloads

1 download since deposited on 18 Dec 2018
1 download 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
Uncontrolled Keywords:Toxicology, Pharmacology (medical), Pharmacology
Language:English
Date:1 April 2019
Deposited On:18 Dec 2018 14:49
Last Modified:24 Sep 2019 23:57
Publisher:Springer
ISSN:0114-5916
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s40264-018-0756-x
Project Information:
  • : FunderFP7
  • : Grant ID201804
  • : Project TitleEUCILIA - Pathophysiology of rare diseases due to ciliary dysfunction: nephronophthisis, Oral-facial-digital type 1 and Bardet-Biedl syndromes

Download

Closed Access: Download allowed only for UZH members