Doctors Issuing Electronic Prescriptions Override Most Safety Alerts

A new study has found that clinicians often override the automatic alerts of potential medication errors built into computer-based prescribing systems, preferring to rely on their own judgment.

Researchers at Dana-Farber Cancer Institute (Boston, MA, USA) and Beth Israel Deaconess Medical Center (BIDMC, Boston, MA, USA), reviewed the electronic prescriptions and associated medication safety alerts generated by 2,872 clinicians at community-based outpatient practices in the [U.S.] states of Massachusetts, New Jersey, and Pennsylvania to learn how clinicians responded to the alerts. The clinicians submitted 3.5 million electronic prescriptions between January 1, and September 30, 2006; approximately one in 15 prescription orders (6.6%) produced an alert for a drug interaction or a drug allergy. The vast majority of the 233,537 alerts (98.6%) were for a potential interaction with a drug a patient already takes.

The study found that the clinicians overrode more than 90% of the drug interaction alerts and 77% of the drug allergy alerts. Even when a drug interaction alert was rated with high severity, clinicians typically dismissed those for medications commonly used in combination to treat specific diseases. They also were less likely to accept an alert if the patient had previously been treated with the medication. The high override rate of all alerts, the researchers contend, suggests that the utility of electronic medication alerts is inadequate, adding that for some clinicians, most alerts could be more of a nuisance than an asset. Based on the study findings, the researchers offered several recommendations to improve medication safety alerts, including reclassifying severity of alerts, especially those that are frequently overridden; providing an option for clinicians to suppress alerts for medications a patient already has received; and customizing the alerts for a clinician's specialty. The study was published in the February 9, 2009, issue of the Archives of Internal Medicine.

"Electronic prescribing clearly will improve medication safety, but its full benefit will not be realized without the development and integration of high-quality decision support systems to help clinicians better manage medication safety alerts,” said senior author, Saul Weingart, M.D., Ph.D., vice president for patient safety at Dana-Farber and an internist at BIDMC.

"The sheer volume of alerts generated by electronic prescribing systems stands to limit the safety benefits,” said first author Thomas Isaac, M.D., MBA, MPH. "Too many alerts are generated for unlikely events, which could lead to alert fatigue. Better decision support programs will generate more pertinent alerts, making electronic prescribing more effective and safer.”

Related Links:
Dana-Farber Cancer Institute
Beth Israel Deaconess Medical Center