Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department

Abstract

ObjectivesTo reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments.MethodsA retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs.ResultsAmong 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%).ConclusionsWe confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.

Decrease in use of contraindicated drugs with automated alerts in children

“…First, computerized alerts for age contraindication may have been overridden for the drug classes by the prescribers. Most of the alerts (89%) generated for anti‐inflammatory and anti‐rheumatic drugs were overridden in a tertiary hospital in Korea . Overrides of medication‐related clinical decision support alerts were very common in a UK tertiary hospital setting .…”

“…Most of the alerts (89%) generated for anti-inflammatory and anti-rheumatic drugs were overridden in a tertiary hospital in Korea. 21 Overrides of medicationrelated clinical decision support alerts were very common in a UK tertiary hospital setting. 22 In a US outpatient setting, alerts for age-related medication recommendations were highly likely to be overridden.…”

New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea

“…Therefore, all free-text data were classified manually by two researchers (JC, KBY) and evaluated by RWP. In this study, the exception processing codes of Grizzle et al [ 10 ] and Ahn et al [ 11 ] were referenced in classification. Grizzle et al [ 10 ] developed 14 categories for overriding DDI alerts and prescribers classified their messages into the categories after excluding duplicated messages from ambulatory pharmacy dispensing records.…”

Optimizing Drug-Drug Interaction Alerts Using a Multidimensional Approach

“…Override rates and reasons for overriding can also vary across departments within a single institution and across alert types. 22,31,32 Metrics that can provide more information on appropriateness and value, such as alert adherence rate, 9,10 require increased clinician insight and cannot be easily obtained from an automated report. Other metrics have been recently introduced but need additional refinement.…”