The Effect of Eliminating Intermediate Severity Drug-Drug Interaction Alerts on Overall Medication Alert Burden and Acceptance Rate

Abstract

Objective This study aimed to determine the effects of reducing the number of drug-drug interaction (DDI) alerts in an order entry system. Methods Retrospective pre–post analysis at an urban medical center of the rates of medication alerts and alert acceptance during a 5-month period before and 5-month period after the threshold for firing DDI alerts was changed from “intermediate” to “severe.” To ensure that we could determine varying response to each alert type, we took an in-depth look at orders generating single alerts. Results Before the intervention, 241,915 medication orders were placed, of which 25.6% generated one or more medication alerts; 5.3% of the alerts were accepted. During the postintervention period, 245,757 medication orders were placed of which 16.0% generated one or more medication alerts, a 37.5% relative decrease in alert rate (95% confidence interval [CI]: −38.4 to −36.8%), but only a 9.6% absolute decrease (95% CI: −9.4 to −9.9%). 7.4% of orders generating alerts were accepted postintervention, a 39.6% relative increase in acceptance rate (95% CI: 33.2–47.2%), but only a 2.1% absolute increase (95% CI: 1.8–2.4%). When only orders generating a single medication alert were considered, there was a 69.1% relative decrease in the number of orders generating DDI alerts, and an 85.7% relative increase in the acceptance rate (95% CI: 58.6–126.2%), though only a 1.8% absolute increase (95% CI: 1.3–2.3%). Conclusion Eliminating intermediate severity DDI alerts resulted in a statistically significant decrease in alert burden and increase in the rate of medication alert acceptance, but alert acceptance remained low overall.

A Study on Design, Development, Implementation, and Evaluation of Severe Drug-Drug Interaction Alert System in ICU

“…Our results are consistent with Paterno et al study (33), which showed that classi cation of DDIs by severity increases compliance rate (33). Also, Knight et al indicated that removing moderate severity DDIAs decreases the override rate, albeit they remained high (34). There are several potential reasons for the low rate of overridden DDIAs in our study; Firstly, triggered DDIAs at the exact point and time of prescribing of the order by the physician in CPOE system.…”

Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions

“…Indeed, a rising number of computer decisionsupport systems and dedicated applications is available to help clinicians manage polytherapy in real life conditions of busy practice (Eyigor and Kutsal, 2012;Patterson et al, 2012;Patterson et al, 2014;Cooper et al, 2015;Bokhof and Junius-Walker, 2016;Sinnige et al, 2016). Of course, such solutions possess some disadvantages also: they produce dozens of alerts, of which some are of low clinical usefulness, and therefore, subject to overriding (Knight et al, 2019).…”

A retrospective look at the predictions and recommendations from the 2009 AMIA policy meeting: did we see EHR-related clinician burnout coming?

“… 18 Other work has focused on reducing the burden created by excessive alerts. 19 , 20 The degree of clinician burnout has become so concerning that it was addressed in a National Academy of Medicine report, to which a number of ACMI members (including author DD) contributed. 21 The concerns about EHR user interfaces were also recognized a decade ago, and research has addressed user interface needs.…”