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Clinicians overrode most electronic prescribing system alerts
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Clinicians frequently ignored alerts generated by electronic prescribing systems, which may suggest that current safety alerts are not adequate to protect patient safety.
Researchers did a retrospective analysis of 233,537 medication safety alerts generated by 2,872 clinicians. All participants in the study used the PocketScript electronic prescribing system.
The researchers found that 6.6% of all prescriptions generated alerts. The vast majority (98.3%) of these alerts were drug-drug interaction alerts; the remaining 1.7% was allergy alerts.
Clinicians accepted 23.0% of allergy alerts and 9.2% of interaction alerts. Almost two-thirds (62.6%) of interaction alerts were high-severity and 29.6% were moderate-severity. Prescribers accepted 10.4% of high-severity alerts vs. 7.3% of moderate-severity and 7.1% of low-severity alerts (P<.001). Even among high-severity alerts, however, acceptance rates ranged from 2.2% to 43% depending on the classes of the interacting drugs.
The researchers also found that clinicians were less likely to accept an interaction alert if the patient had been assigned the alerted medication in the past (OR=0.03; 95% CI, 0.03-0.03).
“Given the high override rate of all alerts, it appears that the utility of electronic medication alerts in outpatient practice is grossly inadequate,” the researchers wrote. “For active clinicians, most alerts may be more of a nuisance than an asset.”
Ann Intern Med. 2009;169:305-311.