View source for Optimization of drug–drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard

Alert fatigue can become a serious safety issue for hospitalized patients in "deactivating clinically irrelevant [[Drug-drug interaction|drug–drug interaction (DDI)]] alert rules"<ref name="Simpao 2014">Simpao AF, Ahumada LM, Desai BR, Bonafide CP, Gálvez JA, Rehman MA, Jawad AF,  Palma KL, Shelov ED, 2014, Creating Optimization of drug-drug interaction alert rules in pediatric hospital's electronic health record system using a visual analytics dashboard, Journal of the American Medical Informatics Association, 2014,0:1-7(http://dx.doi.org/10.1136/amiajnl-2013-002538)</ref> can assist with decreasing potential alert fatigue and lead to increased patient safety.

==Background==

The development of [[EHR|EHR]] and [[CPOE|CPOE]] have assisted with decreasing medication errors and with the implementation of a [[CDS|CDS]] support system we now have alerts for potential drug interactions.  This development as well is for patient safety.  The downfall has been that perhaps at times CDS support systems can implement many [[Alerts|alerts]] and could potentially cause [[Alerts#Alert_fatigue| alert fatigue]] for providers, including the pharmacy staff.  These alerts are at times clinically irrelevant. <ref name="Simpao 2014"></ref>

==Methods==

This study was conducted over a 3 year span from January 11,2011 to January 26,2014 during which the hospital sought a third party vendor to assist with [[Drug-drug interaction|DDI]] alerts.  Due to the number of alerts implemented, the hospital then turned to a visual analytics dashboard in assisting with identifying which alerts were relevant and which were not.  This was achieved with the input of pediatrics, providers, and pharmacy staff as well as the hospital stakeholders. <ref name= "Simpao 2014"></ref> During the implementation of turning off alerts, everything was closely monitored and the fears of missing a major DDI did not occur.<ref name= "Simpao 2014"></ref>

==Results==
After the implementation of deactivating alerts there was a significant decrease in override of alerts. Providers and pharmacy staff noted a decrease in DDI overrides. However, they did not see a decrease in override of the actual viewing.  There was total of 7.51% with the first intervention.  Total of 3 interventions took place and after 3 years there was a significant decrease in overrides.<ref name="Simpao 2014"></ref>

==Conclusion==
It is possible to safely deactivate alerts and still have patient safety as priority. <ref name= "Simpao 2014"></ref>

==Comments==
Patient safety is always a concern in any institution.  If ever a situation arises in which alerts become an issue, it is comforting to know that there are other success in deactivating alerts that are clinically irrelevant have a positive impact.

== Related Articles == 

[[Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care]]


==References==
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[[Category: Reviews]]
[[Category: CDS]]
[[Category: EHR]]
[[Category: CPOE]]