title: A clinical case of electronic health record drug alert fatigue: consequences for patient outcome.
abstract: Despite advances in electronic medication order entry systems, it has been well established that clinicians override many drug allergy alerts generated by the electronic health record. The direct clinical consequences of overalerting clinicians in a pediatric setting have not been well demonstrated in the literature. We observed a patient in the PICU who experienced complications as a result of an extended series of non-evidence-based alerts in the electronic health record. Subsequently, evidence-based allergy alerting changes were made to the hospital's system. Incorporating clinical evidence in electronic drug allergy alerting systems remains challenging, especially in pediatric settings.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. npageler@stanford.edu
authors.forename: C William
authors.initials: CW
authors.lastname: Carspecken
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: Christopher
authors.initials: C
authors.lastname: Longhurst
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Pageler
mesh_terms: D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity; D057286:Electronic Health Records; D019317:Evidence-Based Medicine; D005221:Fatigue; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors; D010818:Practice Patterns, Physicians'
keywords: adverse drug event; alert fatigue; clinical decision support systems; drug allergy; electronic health record; override; pediatrics; quality improvement