Overridden Alerts Linked to Increase in Adverse Drug Events

Alexandra Wilson Pecci, March 27, 2018

Overriding alerts that are clinically relevant can potentially lead to harm.

Adrian Wong

Two things are likely familiar to any physician working in an electronic medical record: Seeing clinical decision support (CDS) alerts and overriding those alerts.

Such alerts remind clinicians about everything from a patient's drug allergies, to possible drug interactions, to dosing guidelines, to lab testing guidance. Clinicians can either follow the alerts' recommendations or override or ignore them.

"They're frequently overridden, and often these are done appropriately," says Adrian Wong, PharmD, MPH, BCPS, BCCCP, an outcomes research and pharmacy informatics fellow in the division of general internal medicine and primary care at Brigham and Women's Hospital.

However, overriding alerts that are clinically relevant can potentially lead to harm.

That's the conclusion of a new study in BMJ Quality & Safety, "Prospective evaluation of medication-related clinical decision support over-rides in the intensive care unit."

The prospective observational study examined medication-related CDS over-rides among adults admitted to any of six Brigham and Women's ICUs between July 2016 and April 2017.

The study included 2,448 over-ridden alerts from 712 unique patient encounters. Although 81.6% of the overrides were appropriate, the "inappropriate over-rides were six times as likely to be associated with potential and definite ADEs [adverse drug events], compared with appropriate over-rides."

For example, in two cases in the study, physicians ordered certain medications even though there was a "reaction that was documented" and "there were other alternative options available," says Wong, the study's lead author. In both cases, the patients had a similar adverse drug event to what was documented.

Alexandra Wilson Pecci

Alexandra Wilson Pecci is an editor for HealthLeaders Media.

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