S.P. Slight
Are we heeding the warning signs? Examining providers' overrides of computerized drug-drug interaction alerts in primary care
Slight, S.P.; Seger, D.L.; Nanji, K.C.; Cho, I.; Maniam, N.; Dykes, P.C.; Bates, D.W.
Authors
D.L. Seger
K.C. Nanji
I. Cho
N. Maniam
P.C. Dykes
D.W. Bates
Abstract
Background: Health IT can play a major role in improving patient safety. Computerized physician order entry with decision support can alert providers to potential prescribing errors. However, too many alerts can result in providers ignoring and overriding clinically important ones. Objective: To evaluate the appropriateness of providers’ drug-drug interaction (DDI) alert overrides, the reasons why they chose to override these alerts, and what actions they took as a consequence of the alert. Design: A cross-sectional, observational study of DDI alerts generated over a three-year period between January 1st, 2009, and December 31st, 2011. Setting: Primary care practices affiliated with two Harvard teaching hospitals. The DDI alerts were screened to minimize the number of clinically unimportant warnings. Participants: A total of 24,849 DDI alerts were generated in the study period, with 40% accepted. The top 62 providers with the highest override rate were identified and eight overrides randomly selected for each (a total of 496 alert overrides for 438 patients, 3.3% of the sample). Results: Overall, 68.2% (338/496) of the DDI alert overrides were considered appropriate. Among inappropriate overrides, the therapeutic combinations put patients at increased risk of several specific conditions including: serotonin syndrome (21.5%, n=34), cardiotoxicity (16.5%, n=26), or sharp falls in blood pressure or significant hypotension (28.5%, n=45). A small number of drugs and DDIs accounted for a disproportionate share of alert overrides. Of the 121 appropriate alert overrides where the provider indicated they would “monitor as recommended”, a detailed chart review revealed that only 35.5% (n=43) actually did. Providers sometimes reported that patients had already taken interacting medications together (15.7%, n=78), despite no evidence to confirm this. Conclusions and Relevance: We found that providers continue to override important and useful alerts that are likely to cause serious patient injuries, even when relatively few false positive alerts are displayed.
Citation
Slight, S., Seger, D., Nanji, K., Cho, I., Maniam, N., Dykes, P., & Bates, D. (2013). Are we heeding the warning signs? Examining providers' overrides of computerized drug-drug interaction alerts in primary care. PLoS ONE, 8(12), Article 85071. https://doi.org/10.1371/journal.pone.0085071
Journal Article Type | Article |
---|---|
Acceptance Date | Nov 22, 2013 |
Online Publication Date | Dec 26, 2013 |
Publication Date | Dec 26, 2013 |
Deposit Date | Jan 23, 2014 |
Publicly Available Date | Mar 31, 2014 |
Journal | PLoS ONE |
Publisher | Public Library of Science |
Peer Reviewed | Peer Reviewed |
Volume | 8 |
Issue | 12 |
Article Number | 85071 |
DOI | https://doi.org/10.1371/journal.pone.0085071 |
Files
Published Journal Article
(345 Kb)
PDF
Copyright Statement
© 2013 Slight et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
You might also like
Patients' perceptions and experiences of patient safety in primary care in England
(2016)
Journal Article
Downloadable Citations
About Durham Research Online (DRO)
Administrator e-mail: dro.admin@durham.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search