Overrides of Medication Alerts in Ambulatory Care

From White Coat (EP Monthly):

A recent Archives of Internal Medicine study titled “Overrides of Medication Alerts in Ambulatory Care” shows that the same concept holds true when doctors prescribe medications through a computer program.

Researchers studied more than 3.5 million electronic prescriptions written using a specific electronic prescribing system in several states between January and September 2006. They tracked 2872 total clinicians, looking to see how the clinicians would respond to “alerts” programmed into the electronic prescribing system. Alerts were programmed for allergies to medications and for potentially dangerous interactions between drugs being prescribed.

Of the 3.5 million prescriptions tracked, roughly half a million total “alerts” were generated by the electronic prescribing system. Half of those alerts were excluded by the researchers because they were “duplicate” alerts that occurred after the prescriber overrode the first alert.

The remaining 233,000 alerts were then studied to show how often prescribers accepted the alerts. Not surprisingly, the alerts were often ignored. “Drug-Drug Interaction” alerts were overridden 91% of the time and “allergy” alerts were overridden 77% of the time.

The researchers concluded that “Given the high override rate of all alerts, it appears that the utility of electronic medication alerts in outpatient practice is grossly inadequate … For active clinicians, most alerts may be more of a nuisance than an asset.”

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