Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care
Open accessAbstract
BACKGROUND: Health IT can play a major role in improving patient safety. Computerized physician order entry with decision support can alert providers to potential prescribing errors. However, too many alerts can result in providers ignoring and overriding clinically important ones. OBJECTIVE: To evaluate the appropriateness of providers' drug-drug interaction (DDI) alert overrides, the reasons why they chose to override these alerts, and what actions they took as a consequence of the alert. DESIGN: A cross-sectional, observational study of DDI alerts generated over a three-year period between January 1st, 2009, and December 31st, 2011. SETTING: Primary care practices affiliated with two Harvard teaching hospitals. The DDI alerts were screened to minimize the number of clinically unimportant warnings. PARTICIPANTS: A total of 24,849 DDI alerts were generated in the study period, with 40% accepted. The top 62 providers with the highest override rate were identified and eight overrides randomly selected for each (a total of 496 alert overrides for 438 patients, 3.3% of the sample). RESULTS: Overall, 68.2% (338/496) of the DDI alert overrides were considered appropriate. Among inappropriate overrides, the therapeutic combinations put patients at increased risk of several specific conditions including: serotonin syndrome (21.5%, n=34), cardiotoxicity (16.5%, n=26), or sharp falls in blood pressure or significant hypotension (28.5%, n=45). A small number of drugs and DDIs accounted for a disproportionate share of alert overrides. Of the 121 appropriate alert overrides where the provider indicated they would "monitor as recommended", a detailed chart review revealed that only 35.5% (n=43) actually did. Providers sometimes reported that patients had already taken interacting medications together (15.7%, n=78), despite no evidence to confirm this. CONCLUSIONS AND RELEVANCE: We found that providers continue to override important and useful alerts that are likely to cause serious patient injuries, even when relatively few false positive alerts are displayed.
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The lack of correlation between alert quantity and override rate supports prior evidence that reducing the number of alerts will not appreciably increase physician acceptance or reduce overrides.
“The lack of correlation between alert quantity and override rate also supports prior evidence that reducing the number of alerts will not appreciably increase physician acceptance or reduce overrides [23].”
From Drug interaction alert override rates in the Meaningful Use era: No evidence of progress (2014) · cites this paper as [23]
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- Authors
- Slight, S. P., Seger, D. L., Nanji, K. C., Cho, I., Maniam, N., Dykes, P. C., & Bates, D. W.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Corresponding author
- Slight, Sarah P.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-12-26
- Volume
- 8
- Issue
- 12
- Pages
- e85071
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3873469
- OpenAlex
- W1969908081
- Cited by
- 86
- References
- 18
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 10 · 2021: 7 · 2020: 3 · 2019: 9 · 2018: 12 · 2017: 4 · 2016: 11 · 2015: 9 · 2014: 6
- FWCI
- 14.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (acceptedVersion, other-oa)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Agency for Healthcare Research and Quality
- 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
- drug-drug interaction alerts, alert override, clinical decision support, computerized physician order entry, prescribing errors, patient safety, primary care, serotonin syndrome, cardiotoxicity, hypotension, false positive alerts
- MeSH terms
- Attitude of Health Personnel, Cross-Sectional Studies, Drug Interactions, Female, Hospitals, Teaching, Humans, Male, Medical Order Entry Systems
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