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

Abstract

The appropriateness of medication-related clinical decision support overrides in the ICU varied substantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.

Prospective evaluation of medication-related clinical decision support over-rides in the intensive care unit

“…For geriatric alerts, an interesting finding was that the acceptance of these alerts (97.5%) was much more common than reported in the literature 8. This acceptance rate was also significantly greater than the rest of the studied alert types.…”

“…Two prospective cohort studies identifying ADEs in the ICU found that they were relatively common (30.6–96.5 per 1000 patient-days), and associated with increased morbidity 12 13. A study performed at our institution using our legacy, home-grown electronic health record (EHR) system found that inappropriately over-ridden CDS alerts were associated with an increased risk of ADEs 8. However, this study had limitations including that it was retrospective, had a small sample size, and there were concerns about generalisability as it was done within a home-grown system.…”

Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System

“…Available literature is limited to general CDS and is not specific to the ICU. Evaluations of CDS in the ICU have mainly focused on internally developed systems and few have been done [14]. With the growing proportion of healthcare institutions adopting commercially available EHR systems, this study shows the importance of evaluating changes in CDS after the transition to ensure that quality improvement efforts are continued.…”

Impact of Passive Laboratory Alerts on Navigating Electronic Health Records in Intensive Care Simulations

“…Ultimately, clinicians disregard from 70% to more than 90% of active alerts, the majority of which are false positives (Nanji et al, 2017;Wong et al, 2017;Straichman et al, 2017). The frequency of exposure to false positive CPOE alerts has been associated with inappropriate alert overrides (Miller, Boro, Korman, & Davoren, 2011), a behavior which has been associated with adverse events (Wong et al, 2017). Despite over a decade of literature describing active EHR alerts and their optimization, reducing alert fatigue remains a concern and a target for quality improvement efforts (Kane-Gill et al, 2017;Payne et al, 2015).…”