| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on February 9, 2004
Accepted on July 14, 2004
Affiliation of the authors: 1 Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA; 2 Department of Clinical Practice Evaluation, New York-Presbyterian Hospital, New York, NY; 3 The Advisory Board Company, Washington, D.C.
* To whom correspondence should be addressed.
Objective To study characteristics of drug-allergy alert overrides, assess how often they lead to preventable adverse drug events (ADEs), and suggest methods for improving the allergy-alerting system.
Design Chart review was performed on a stratified random subset of all allergy alerts occurring during a 3-month period (August-October 2002) at a large academic hospital.
Measurements Drug/allergy combinations that triggered alerts; frequency of specific override reasons; characteristics of ADEs; completeness of allergy documentation.
Results 6,182 (80%) of 7,761 total alerts were overridden in 1,150 patients. In this sample, only 10% of alerts were triggered by an exact match between the drug ordered and allergy listed. Physicians' most common reasons for overriding alerts were "Aware / Will monitor" (55%), "Patient does not have this allergy / Tolerates" (33%), and "Patient taking already" (10%). In a stratified random subset of 320 patients (28% of 1,150) on chart review, 19 (6%) experienced ADEs attributed to the overridden drug; of these, 9 (47%) were serious. None of the ADEs was considered preventable because the overrides were deemed clinically justifiable. The degree of completeness of patients' allergy lists was highly variable and generally low in both paper charts and the CPOE system.
Conclusion Overrides of drug-allergy alerts were common and about 1 in 20 resulted in ADEs, but all of the overrides resulting in ADEs appeared clinically justifiable. The high rate of alert overrides was attributable to frequent non-exact-match alerts and infrequent updating of allergy lists. Based on these findings, we have made specific recommendations for increasing the specificity of alerting and thereby improving the clinical utility of the drug-allergy alerting system.
This article has been cited by other articles:
 |
|
 |
|
  H. van der Sijs, J. Aarts, T. van Gelder, M. Berg, and A. Vulto Turning Off Frequently Overridden Drug Alerts: Limited Opportunities for Doing It Safely J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 439 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Tamblyn, A. Huang, L. Taylor, Y. Kawasumi, G. Bartlett, R. Grad, A. Jacques, M. Dawes, M. Abrahamowicz, R. Perreault, et al. A Randomized Trial of the Effectiveness of On-demand versus Computer-triggered Drug Decision Support in Primary Care J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 430 - 438. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Dexheimer, T. R. Talbot, D. L. Sanders, S. T. Rosenbloom, and D. Aronsky Prompting Clinicians about Preventive Care Measures: A Systematic Review of Randomized Controlled Trials J. Am. Med. Inform. Assoc., May 1, 2008; 15(3): 311 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Kuperman, A. Bobb, T. H. Payne, A. J. Avery, T. K. Gandhi, G. Burns, D. C. Classen, and D. W. Bates Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review J. Am. Med. Inform. Assoc., January 1, 2007; 14(1): 29 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Campbell, D. F. Sittig, J. S. Ash, K. P. Guappone, and R. H. Dykstra Types of Unintended Consequences Related to Computerized Provider Order Entry J. Am. Med. Inform. Assoc., September 1, 2006; 13(5): 547 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S C Porter, S F Manzi, D Volpe, and A M Stack Getting the data right: information accuracy in pediatric emergency medicine. Qual. Saf. Health Care, August 1, 2006; 15(4): 296 - 301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Judge, T. S. Field, M. DeFlorio, J. Laprino, J. Auger, P. Rochon, D. W. Bates, and J. H. Gurwitz Prescribers' Responses to Alerts During Medication Ordering in the Long Term Care Setting J. Am. Med. Inform. Assoc., July 1, 2006; 13(4): 385 - 390. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Kuperman, R. M. Reichley, and T. C. Bailey Using Commercial Knowledge Bases for Clinical Decision Support: Opportunities, Hurdles, and Recommendations J. Am. Med. Inform. Assoc., July 1, 2006; 13(4): 369 - 371. [Full Text] [PDF]
|
|
|
|
|
|
H. van der Sijs, J. Aarts, A. Vulto, and M. Berg Overriding of Drug Safety Alerts in Computerized Physician Order Entry J. Am. Med. Inform. Assoc., March 1, 2006; 13(2): 138 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. R. Shah, A. C. Seger, D. L. Seger, J. M. Fiskio, G. J. Kuperman, B. Blumenfeld, E. G. Recklet, D. W. Bates, and T. K. Gandhi Improving Acceptance of Computerized Prescribing Alerts in Ambulatory Care J. Am. Med. Inform. Assoc., January 1, 2006; 13(1): 5 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Longo, J. E. Hewett, B. Ge, and S. Schubert The Long Road to Patient Safety: A Status Report on Patient Safety Systems JAMA, December 14, 2005; 294(22): 2858 - 2865. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Berner and J. Moss Informatics Challenges for the Impending Patient Information Explosion J. Am. Med. Inform. Assoc., November 1, 2005; 12(6): 614 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Buurma, P. A. De Smet, M. Kruijtbosch, and A. C. Egberts Disease and Intolerability Documentation in Electronic Patient Records Ann. Pharmacother., October 1, 2005; 39(10): 1640 - 1646. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Nebeker, J. M. Hoffman, C. R. Weir, C. L. Bennett, and J. F. Hurdle High Rates of Adverse Drug Events in a Highly Computerized Hospital Arch Intern Med, May 23, 2005; 165(10): 1111 - 1116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. L. Galanter, R. J. Didomenico, and A. Polikaitis A Trial of Automated Decision Support Alerts for Contraindicated Medications Using Computerized Physician Order Entry J. Am. Med. Inform. Assoc., May 1, 2005; 12(3): 269 - 274. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. N. Sciamanna Will High-Quality Care Be the Norm by the Time I Need It? American Journal of Medical Quality, January 1, 2005; 20(1): 5 - 6. [PDF]
|
|
|
|
|
|
R. M. Gardner and R. S. Evans Using Computer Technology to Detect, Measure, and Prevent Adverse Drug Events J. Am. Med. Inform. Assoc., November 1, 2004; 11(6): 535 - 536. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
