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

• DOI: 10.1371/journal.pone.0085071
• Publication Date: 2013-12-26T22:38:19Z
• Authors: Sarah P. Slight; Diane L. Seger; Karen C. Nanji; Insook Cho; Nivethietha Maniam; Patricia C. Dykes; David W. Bates
• Keywords: Order entry

BackgroundHealth IT can play a major role in improving patient safety. Computerized physician order entry with decision support alert providers to potential prescribing errors. However, too many alerts result ignoring and overriding clinically important ones. ObjectiveTo evaluate the appropriateness of providers' drug-drug interaction (DDI) overrides, reasons why they chose override these alerts, what actions took as consequence alert. DesignA cross-sectional, observational study DDI generated over three-year period between January 1st, 2009, December 31st, 2011. SettingPrimary care practices affiliated two Harvard teaching hospitals. The were screened minimize number unimportant warnings. ParticipantsA total 24,849 period, 40% accepted. top 62 highest rate identified eight overrides randomly selected for each (a 496 438 patients, 3.3% sample). ResultsOverall, 68.2% (338/496) considered appropriate. Among inappropriate therapeutic combinations put patients at increased risk several specific conditions including: serotonin syndrome (21.5%, n=34), cardiotoxicity (16.5%, n=26), or sharp falls blood pressure significant hypotension (28.5%, n=45). A small drugs DDIs accounted disproportionate share overrides. Of 121 appropriate where provider indicated would "monitor recommended", detailed chart review revealed that only 35.5% (n=43) actually did. Providers sometimes reported had already taken interacting medications together (15.7%, n=78), despite no evidence confirm this. Conclusions RelevanceWe found continue useful are likely cause serious injuries, even when relatively few false positive displayed.