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Clinicians override most electronic medication safety alerts
Date:2/10/2009

to treat specific diseases. They also were less likely to accept an alert if the patient had previously been treated with the medication.

The high override rate of all alerts, the researchers contend, suggests that the utility of electronic medication alerts is inadequate, adding that for some clinicians, most alerts "may be more of a nuisance than an asset."

"The sheer volume of alerts generated by electronic prescribing systems stands to limit the safety benefits," says Thomas Isaac, MD, MBA, MPH, of BIDMC and Dana-Farber and the paper's first author. "Too many alerts are generated for unlikely events, which could lead to alert fatigue. Better decision support programs will generate more pertinent alerts, making electronic prescribing more effective and safer."

Although the study analyzed orders generated on only one electronic prescribing system, PocketScript, the researchers say their observations are relevant to other systems because the alerts they reviewed were typical and were generated by a commercial database, Cerner Multum, used by other electronic prescribing systems.

Based on these findings, Weingart and his colleagues offer several recommendations to improve medication safety alerts, including reclassifying severity of alerts, especially those that are frequently overridden; providing an option for clinicians to suppress alerts for medications a patient already has received; and customizing the alerts for a clinician's specialty. The research team identified a list of potentially dangerous drug interactions based on those alerts that most often changed the clinicians' decision to prescribe. This list is available at www.dana-farber.org/electronic-medication-safety.

"We need to find a way to help clinicians to separate the proverbial wheat from the chaff," says Weingart. "Until then, electronic prescribing systems stand to fall far short of their promise to enhance patient safety and to generate greater eff
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Contact: Bill Schaller
william_schaller@dfci.harvard.edu
617-632-5357
Dana-Farber Cancer Institute
Source:Eurekalert  

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