A study of the frequency and rationale for overriding allergy warnings in a computerized prescriber order entry system

Abstract

Objectives: The goal of this 2-part study was to quantify the frequency of allergy warnings that were overridden, specify the reasons why a clinician chose to override an alert, and evaluate allergy warnings that were accepted by prescribers. Methods: This was a retrospective analysis of computerized prescriber order entry decision support allergy warnings and the corresponding prescriber decisions during four 1-week intervals and another 16-week interval from August 2003 to February 2005 at a 993-bed tertiary care teaching hospital. The following information was collected: patient allergy status, allergy category, allergy severity, warning provided, clinician category, and the reason warning was overridden. Results: A total of 29,483 evaluated orders triggered 777 allergy warnings, of which, 44% of the warnings were accepted, and 56% of the warnings were overridden. Of the 435 warnings that were overridden by the ordering clinician, 6% of the warnings were drug specific, and 94% were drug class warnings. The primary reason selected for overriding an allergy warning was that the patient tolerated the medication in the past (70%). Of the 342 warnings that were accepted by ordering clinicians, 24% of the warnings were drug specific, and 76% were drug class warnings. Conclusions: Clinicians were much less likely to override a warning if it was an exact drug match compared with a drug class warning. Limiting the number of alerts for less significant drug class warnings would help…