Medication-related clinical decision support alert overrides in inpatients
Open accessAbstract
Objective: To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers’ reasons for overriding them and the appropriateness of those reasons. Materials and Methods: We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons. Results: Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P < .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P < .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate. Discussion: Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate >75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue. Conclusion: Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.
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Edrees et al., Nanji et al. and Wong et al. found override appropriateness rates of 45.4%, 62% and 82%, respectively.
“Edrees et al. [27], Nanji et al. [29] and Wong et al. [31] found override appropriateness rates of 45.4%, 62% and 82%, respectively.”
From Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey (2022) · cites this paper as [29]
The Results report that 62.0% of drug–drug interaction alert overrides were appropriate, so the cited figure appears in Nanji et al. But the sentence presents 62% as an unqualified appropriateness rate; the paper reports an overall average of 61.3% across alert types. The Edrees and Wong figures are attributed to other citations, not this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOur study results are in agreement with previous reports.
“Our study results are in agreement with previous reports.”
From Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey (2022) · cites this paper as [29]
High override rates of 56.3%-95.7% have already been described for DDI alerts.
“High override rates of 56.3%-95.7% have already been described for DDI alerts [13, 21, 27–32].”
From Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey (2022) · cites this paper as [29]
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- Authors
- Nanji, K. C., Seger, D. L., Slight, S. P., Amato, M. G., Beeler, P. E., Her, Q. L., Dalleur, O., Eguale, T., Wong, A., Silvers, E. R., Swerdloff, M., Hussain, S. T., Maniam, N., Fiskio, J. M., Dykes, P. C., & Bates, D. W.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Nanji, Karen C
- ORCID
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-10-27
- Volume
- 25
- Issue
- 5
- Pages
- 476-481
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC7646870
- OpenAlex
- W2765920053
- Cited by
- 179
- References
- 51
- Citations by year
- 2026: 22 · 2025: 17 · 2024: 8 · 2023: 16 · 2022: 43 · 2021: 14 · 2020: 25 · 2019: 23 · 2018: 11
- FWCI
- 22.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Digital Access to Libraries (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (148619)
- Agency for Healthcare Research and Quality (U19HS021094, K08 HS024764)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- clinical decision support alerts, alert override, medication alerts, alarm fatigue, drug-drug interaction alerts, hospitalized patients
- MeSH terms
- Alert Fatigue, Health Personnel, Cross-Sectional Studies, Drug Hypersensitivity, Drug Interactions, Drug Therapy, Computer-Assisted, Humans, Decision Support Systems, Clinical, Medical Order Entry Systems, Meaningful Use
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