Overrides of Medication Alerts in Ambulatory Care

Rosenberg, Stephen; Sullivan, Maureen; Juster, Iver A.; Jacques, Jeffrey

doi:10.1001/archinternmed.2009.224

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…An alert-an automatic warning message meant to communicate essential information to the clinician using an EHRis now generated for 6% to 8% of all orders entered into an EHR by providers. 2,3 Each of these alerts represents an intention to provide useful information to the clinician, shape clinician behavior, and positively impact patient safety and outcomes.…”

Section: Background and Significancementioning

confidence: 99%

“…However, the utility of these warnings is attenuated by unintended consequences such as alert fatigue (clinicians' tendency to ignore repeated alerts) and distraction, especially in an environment where alert volume is high, and many alerts are clinically irrelevant. In fact, 90% to 95% of alerts are overridden, [2][3][4] and this phenomenon has been identified as a cause of several high-profile errors. 5,6 Efforts at minimizing alert fatigue have included tiering alerts by importance and titrating the degree of interaction required by the clinician accordingly.…”

Section: Background and Significancementioning

confidence: 99%

“…8 To inform the appropriate application of alerts, we sought to characterize the risks and benefits of hard stops by asking 3 key questions: (1) To what extent are hard-stop CDS alerts in EHRs effective in improving patient health and healthcare delivery outcomes? (2) What are the unintended consequences and adverse events of computerized hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts in efficacy and unintended consequences?…”

Section: Background and Significancementioning

confidence: 99%

See 2 more Smart Citations

Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review

Powers

Shiffman

Melnick

et al. 2018

Journal of the American Medical Informatics Association

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Section: Background and Significancementioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

See 1 more Smart Citation

Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review

Powers

Shiffman

Melnick

et al. 2018

Journal of the American Medical Informatics Association

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show abstract

“…54,55 The existing insensitivity results in many false-positive alerts and subsequently in override rates ranging from 89% to 91%. 25,[56][57][58] Although few studies have been published that assess this phenomenon in children, children tend to be on fewer chronic medications and, because of generally good renal and hepatic function, may be less at risk for severe adverse reactions, 59 thereby magnifying this concern in pediatrics.…”

Section: E-prescribing System Functional Requirementsmentioning

confidence: 99%

Electronic Prescribing in Pediatrics: Toward Safer and More Effective Medication Management

Johnson¹,

Lehmann²

2013

Pediatrics

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This technical report discusses recent advances in electronic prescribing (e-prescribing) systems, including the evidence base supporting their limitations and potential benefits. Specifically, this report acknowledges that there are limited but positive pediatric data supporting the role of e-prescribing in mitigating medication errors, improving communication with dispensing pharmacists, and improving medication adherence. On the basis of these data and on the basis of federal statutes that provide incentives for the use of e-prescribing systems, the American Academy of Pediatrics recommends the adoption of e-prescribing systems with pediatric functionality. This report supports the accompanying policy statement from the American Academy of Pediatrics recommending the adoption of e-prescribing by pediatric health care providers. Pediatrics 2013;131:e1350-e1356The US health care system has the distinction of being the world' s most expensive delivery system while also having among the lowest levels of quality, as judged by many metrics, including infant mortality, life expectancy, and potential years of life lost. 1,2 More specifically, despite US leadership in establishing many standards of care that correlate with improved quality, the US health care system is able to deliver, at best, 60% of the recommended care in most practices. 3,4 Reasons for this inefficiency include the voluminous information resources to consult and the experts' parallel processing and modeling skills (including integrating considerations of the patient' s other illnesses, lifestyle, and genome) required to make an optimal decision. 5 Other challenges include the health care system' s existing methods of payment, which lead to fragmented care. 6 Difficult-to-resolve health disparities also occur when there are suboptimal interactions between a person' s preferences, the regulatory/operational health care system, and internalized biases, stereotypes, or knowledge deficits. All of these challenges to information management affect the delivery of care. 7 For these reasons, health information technology (HIT) has become recognized as a set of tools that complement the provision of care. 8 Electronic prescribing (e-prescribing) is widely recognized as a component of the prescribing process that facilitates handoffs, improves clinical decision-making, and may improve medication adherence. E-prescribing was defined in 2008 by the Centers for Medicare and Medicaid Services as a system providing prescribers with

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“…Many hospitals have adopted clinical decision support systems (CDSSs) with a DDI alerting function to improve the quality and efficiency of care and to increase patient safety by reducing medication errors [ 6 , 7 ]. However, high rates of alert overrides have been reported for DDI alerts [ 8 , 9 ] because of clinically inappropriate alerts [ 10 , 11 , 12 ], 'alert fatigue' due to excessive alerts [ 13 ], or intended prescriptions [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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.

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Overrides of Medication Alerts in Ambulatory Care

Cited by 8 publications

References 3 publications

Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review

Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review

Electronic Prescribing in Pediatrics: Toward Safer and More Effective Medication Management

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

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