Outpatient providers at one large academic medical center overrode drug alerts about half the time, and about half the time, the overrides were appropriate, a study found.
Researchers reviewed data from outpatient clinics and ambulatory hospital-based practices at a large academic health care center from January 2009 to December 2011. Results appeared online Oct. 28 in the Journal of the American Medical Informatics Association.
More than 1,700 providers received nearly 160,000 alerts for more than 2 million prescriptions during the study (7.9%). Physicians, house-staff, and non-physicians with prescribing authority overrode nearly 83,000 (52.6%) alerts. The most common alerts were for duplicate drugs (33.1%), allergies (16.8%) and drug-drug interactions (15.8%). The most likely alerts to be overridden were formulary substitutions (85%), age-based recommendations (79%), renal recommendations (78.0%), and allergies (77.4%).
An average of 53% of all overrides were appropriate, although rates of appropriateness varied by alert type (P<0.0001), from 12% for renal recommendations to 92% for patient allergies. One common reason to override the alert was that patients had tolerated the drugs in the past. When broken down by type of alert, the most common reason for overriding drug-drug interactions was that the provider would monitor the prescription (42%). The most common reason for overriding formulary substitutions was failure to respond to or intolerance to the substitute drug.
Researchers noted that the vast majority of drug allergy, drug-class, duplicate drug, and drug formulary alerts were appropriate. It might reduce alert fatigue to refine and reduce the number of alerts for formularies, they suggested. And, overrides of drug-class and class-class alerts were more often appropriate than were individual drug-drug alerts. This suggests that while providers generally agree with alerts for drug categories, they may feel that exceptions exist for drugs within the class.
Researchers concluded, “Future research should investigate the appropriateness of overrides given the specific clinical context, in order to optimize alert types and frequencies to increase their relevance for patient care, as well as the clustering of overrides by provider in order to design effective interventions aimed at reducing inappropriate alert overrides, which could range from extinguishing unnecessary warnings to targeting physicians with inappropriately high override rates.”