Difference between revisions of "Overrides of medication-related clinical decision support alerts in outpatients"
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| − | This is a review of the article, Overrides of medication-related clinical decision support alerts in outpatients. | + | This is a review of the 2014 article by Nanji et al, Overrides of medication-related clinical decision support alerts in outpatients.<ref name="Nanji 2014"> Nanji, K. C., Slight, S. P., Seger, D. L., Cho, I., Fiskio, J. M., Redden, L. M., . . . Bates, D. W. Overrides of medication-related clinical decision support alerts in outpatients. doi: 10.1136/amiajnl-2013-001813. http://jamia.oxfordjournals.org/content/21/3/487.short</ref> |
== Background == | == Background == | ||
| − | + | A large incidence of alert overrides in a prescription clinical decision support (CDS) prompted the authors to investigate the reason and appropriateness of the overrides. Both the electronic health record (EHR) and CDS were internally developed, and had ordering alerts for: | |
| + | *Patient allergies | ||
| + | *Drug-drug interactions | ||
| + | *Age-based recommendations | ||
| + | *Renal recommendations | ||
| + | *Formulary substitutions | ||
| + | *Duplicate drug | ||
| + | *Drug-class interaction | ||
| + | *Class-class interaction | ||
| + | |||
== Methods == | == Methods == | ||
| − | + | The incidence of CDS overrides was obtained from the EHR’s audit logs. The appropriateness of the overrides was determined based on criteria created by four clinicians: a physician, nurse, and two pharmacists. A sample of 600 alert overrides from a three-year time period was evaluated. | |
| − | + | ||
== Results == | == Results == | ||
| + | Over three years, there were 2,004,069 medication order CDS alerts, and 56.2% of these alerts were overridden. 53% of the overrides were appropriate, and they were in the categories of patient allergy, drug-class, duplicate drug, and drug formulary. The inappropriate overrides were in the categories of renal recommendations, drug-drug interactions, and age-based recommendations. | ||
| + | |||
| + | == Conclusion == | ||
| + | |||
| + | The authors concluded that the CDS needed to be evaluated to make it relevant and decrease alert fatigue. They also surmised that education needed to be given to clinicians on the categories where the alert overrides were inappropriate. | ||
== Comments == | == Comments == | ||
Revision as of 00:40, 17 February 2015
This is a review of the 2014 article by Nanji et al, Overrides of medication-related clinical decision support alerts in outpatients.[1]
Background
A large incidence of alert overrides in a prescription clinical decision support (CDS) prompted the authors to investigate the reason and appropriateness of the overrides. Both the electronic health record (EHR) and CDS were internally developed, and had ordering alerts for:
- Patient allergies
- Drug-drug interactions
- Age-based recommendations
- Renal recommendations
- Formulary substitutions
- Duplicate drug
- Drug-class interaction
- Class-class interaction
Methods
The incidence of CDS overrides was obtained from the EHR’s audit logs. The appropriateness of the overrides was determined based on criteria created by four clinicians: a physician, nurse, and two pharmacists. A sample of 600 alert overrides from a three-year time period was evaluated.
Results
Over three years, there were 2,004,069 medication order CDS alerts, and 56.2% of these alerts were overridden. 53% of the overrides were appropriate, and they were in the categories of patient allergy, drug-class, duplicate drug, and drug formulary. The inappropriate overrides were in the categories of renal recommendations, drug-drug interactions, and age-based recommendations.
Conclusion
The authors concluded that the CDS needed to be evaluated to make it relevant and decrease alert fatigue. They also surmised that education needed to be given to clinicians on the categories where the alert overrides were inappropriate.
Comments
References
- ↑ Nanji, K. C., Slight, S. P., Seger, D. L., Cho, I., Fiskio, J. M., Redden, L. M., . . . Bates, D. W. Overrides of medication-related clinical decision support alerts in outpatients. doi: 10.1136/amiajnl-2013-001813. http://jamia.oxfordjournals.org/content/21/3/487.short
