Physicians’ responses to computerized drug interaction alerts with password overrides

Abstract

BackgroundAlthough evidence has suggested that computerized drug-drug interaction alert systems may reduce the occurrence of drug-drug interactions, the numerous reminders and alerts generated by such systems could represent an excessive burden for clinicians, resulting in a high override rate of not only unimportant, but also important alerts.MethodsWe analyzed physicians’ responses to alerts of relative contraindications and contraindications for coadministration in a computerized drug-drug interaction alert system at Hokkaido University Hospital. In this system, the physician must enter a password to override an alert and continue an order. All of the drug-drug interaction alerts generated between December 2011 and November 2012 at Hokkaido University Hospital were included in this study.ResultsThe system generated a total of 170 alerts of relative contraindications and contraindication for coadministration; 59 (34.7 %) of the corresponding orders were cancelled after the alert was accepted, and 111 (65.3 %) were overridden. The most frequent contraindication alert was for the combination of 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors and fibrates. No incidents involving drug-drug interactions were reported among patients who were prescribed contraindicated drug pairs after an override.ConclusionsAlthough computerized drug-drug interaction alert systems that require password overrides appear useful for promoting medication safety, having to enter passwords to override alerts may represent an excessive burden for the prescribing physician. Therefore, both patient safety and physicians’ workloads should be taken into consideration in future designs of computerized drug-drug interaction alert systems.

Prevalence of potential drug-drug interactions and associated factors among outpatients and inpatients in Ethiopian hospitals: a systematic review and meta-analysis of observational studies

“…This alert fatigue results in a considerable override of DDI alerts. A study done in Japan showed physicians overrode DDI alerts at a high rate in computerized drug interaction alert system [18].…”

The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review

“…64 Furthermore, security policies or measures such as providing justification to override password before prescription completion and enforcing role-based access control for clinicians hinder the effective use of CDSS alert. 87…”

“…Three studies in primary care and in outpatient setting showed that deficiencies in organizational rules and security policies impede alert use, contribute to HIT failure, and disrupt workflow. 36,59,87 According to Zazove et al, 55 institutional rules prohibit clinicians from modifying the best practice alert (BPA) fonts, colors, and word placement to suit their personal needs. Another study reported that alerts display information that conflicts with the hospital policy and standard medication practices.…”

Erratum to: Physicians’ responses to computerized drug interaction alerts with password overrides

“…Following publication of our paper in BMC Medical Informatics and Decision Making [ 1 ], it was brought to our attention that we had used a slightly modified version of DIAS which had been originally developed by another group [ 2 ]. We inadvertently failed to include this paper in the reference list.…”