Appl Clin Inform - Drug interaction alert override rates in the Meaningful Use era: no evidence of progress.

Tópicos

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Resumo

CKGROUND: Interruptive drug interaction alerts may reduce adverse drug events and are required for Stage I Meaningful Use attestation. For the last decade override rates have been very high. Despite their widespread use in commercial EHR systems, previously described interventions to improve alert frequency and acceptance have not been well studied.OBJECTIVES: (1) To measure override rates of inpatient medication alerts within a commercial clinical decision support system, and assess the impact of local customization efforts. (2) To compare override rates between drug-drug interaction and drug-allergy interaction alerts, between attending and resident physicians, and between public and academic hospitals. (3) To measure the correlation between physicians' individual alert quantities and override rates as an indicator of potential alert fatigue.METHODS: We retrospectively analyzed physician responses to drug-drug and drug-allergy interaction alerts, as generated by a common decision support product in a large teaching hospital system.RESULTS: (1) Over four days, 461 different physicians entered 18,354 medication orders, resulting in 2,455 visible alerts; 2,280 alerts (93%) were overridden. (2) The drug-drug alert override rate was 95.1%, statistically higher than the rate for drug-allergy alerts (90.9%) (p < 0.001). There was no significant difference in override rates between attendings and residents, or between hospitals. (3) Physicians saw a mean of 1.3 alerts per day, and the number of alerts per physician was not significantly correlated with override rate (R2 = 0.03, p = 0.41).CONCLUSIONS: Despite intensive efforts to improve a commercial drug interaction alert system and to reduce alerting, override rates remain as high as reported over a decade ago. Alert fatigue does not seem to contribute. The results suggest the need to fundamentally question the premises of drug interaction alert systems.

Resumo Limpo

ckground interrupt drug interact alert may reduc advers drug event requir stage meaning use attest last decad overrid rate high despit widespread use commerci ehr system previous describ intervent improv alert frequenc accept well studiedobject measur overrid rate inpati medic alert within commerci clinic decis support system assess impact local custom effort compar overrid rate drugdrug interact drugallergi interact alert attend resid physician public academ hospit measur correl physician individu alert quantiti overrid rate indic potenti alert fatiguemethod retrospect analyz physician respons drugdrug drugallergi interact alert generat common decis support product larg teach hospit systemresult four day differ physician enter medic order result visibl alert alert overridden drugdrug alert overrid rate statist higher rate drugallergi alert p signific differ overrid rate attend resid hospit physician saw mean alert per day number alert per physician signific correl overrid rate r p conclus despit intens effort improv commerci drug interact alert system reduc alert overrid rate remain high report decad ago alert fatigu seem contribut result suggest need fundament question premis drug interact alert system

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