title: Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department.
abstract: OBJECTIVE
  To reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments.
  
  
  METHODS
  A retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs.
  
  
  RESULTS
  Among 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%).
  
  
  CONCLUSIONS
  We confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Eun Kyoung
authors.initials: EK
authors.lastname: Ahn
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Soo-Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Dahye
authors.initials: D
authors.lastname: Shin
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Chul
authors.initials: C
authors.lastname: Jang
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Rae Woong
authors.initials: RW
authors.lastname: Park
keywords: Clinical Decision Support Systems; Contraindications; Drug Interactions; Hospital Admitting Department