Reasons provided by prescribers when overriding drug-drug interaction alerts.
OBJECTIVE
To investigate prescribers' rationales for overriding drug-drug interaction (DDI) alerts and to determine whether these reasons were helpful to pharmacists as a part of prescription order verification.


METHODS
An observational retrospective database analysis was conducted using override reasons derived from a computerized system at 6 Veterans Affairs medical centers.


METHODS
Data on DDI alerts (for interactions designated as "critical" and "significant") were obtained from ambulatory care pharmacy records from July 1, 2003, to June 30, 2004. Prescribers' reasons for overriding alerts were organized into 14 categories and were then rated as clinically useful or not to the pharmacist in the assessment of potential patient harm.


RESULTS
Of 291,890 overrides identified, 72% were for critical DDIs. Across the Veterans Affairs medical centers, only 20% of the override reasons for critical DDI alerts were rated as clinically useful for order verification. Despite a mandatory override reason for critical DDI alerts, 53% of the responses were "no reason provided." The top response categories for critical and significant DDI alerts were "no reason provided," "patient has been taking combination," and "patient being monitored."


CONCLUSIONS
When given the opportunity to provide a reason for overriding a DDI alert, prescribers rarely enter clinical justifications that are useful to order verification pharmacists. This brings into question how computerized physician order entry systems should be designed.
Grizzle
Amy J
AJ
Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ 85721-0202, USA. grizzle@pharmacy.arizona.edu.
Mahmood
Maysaa H
MH
Ko
Yu
Y
Murphy
John E
JE
Armstrong
Edward P
EP
Skrepnek
Grant H
GH
Jones
William N
WN
Schepers
Gregory P
GP
Nichol
W Paul
WP
Houranieh
Antoun
A
Dare
Donna C
DC
Hoey
Christopher T
CT
Malone
Daniel C
DC
D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards* / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control*; D019370:Observation; D010607:Pharmacy Service, Hospital; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States