title: Design and Evaluation of an Electronic Override Mechanism for Medication Alerts to Facilitate Communication Between Prescribers and Pharmacists.
abstract: BACKGROUND
  Computerized medication alerts can often be bypassed by entering an override rationale, but prescribers' override reasons are frequently ambiguous to pharmacists who review orders.
  
  
  OBJECTIVE
  To develop and evaluate a new override mechanism for adverse reaction and drug-drug interaction alerts. We hypothesized that the new mechanism would improve usability for prescribers and increase the clinical appropriateness of override reasons.
  
  
  METHODS
  A counterbalanced, crossover study was conducted with 20 prescribers in a simulated prescribing environment. We modified the override mechanism timing, navigation, and text entry. Instead of free-text entry, the new mechanism presented prescribers with a predefined set of override reasons. We assessed usability (learnability, perceived efficiency, and usability errors) and used a priori criteria to evaluate the clinical appropriateness of override reasons entered.
  
  
  RESULTS
  Prescribers rated the new mechanism as more efficient (Wilcoxon signed-rank test, P = 0.032). When first using the new design, 5 prescribers had difficulty finding the new mechanism, and 3 interpreted the navigation to mean that the alert could not be overridden. The number of appropriate override reasons significantly increased with the new mechanism compared with the original mechanism (median change of 3.0; interquartile range = 3.0; P < 0.0001).
  
  
  CONCLUSIONS
  When prescribers were given a menu-based choice for override reasons, clinical appropriateness of these reasons significantly improved. Further enhancements are necessary, but this study is an important first step toward a more standardized menu of override choices. Findings may be used to improve communication through e-prescribing systems between prescribers and pharmacists.
authors: Richard L. Roudebush Veterans Affiars (VA) Medical Center, Indianapolis, IN, USA Purdue University, West Lafayette, IN, USA Regenstrief Institute, Inc, Indianapolis, IN, USA alissa.russ@va.gov.
authors: Alissa L
authors: AL
authors: Russ
authors: Richard L. Roudebush Veterans Affiars (VA) Medical Center, Indianapolis, IN, USA.
authors: Siying
authors: S
authors: Chen
authors: University of Kansas, Lawrence, KS, USA.
authors: Brittany L
authors: BL
authors: Melton
authors: University of Louisville, Louisville, KY, USA.
authors: Jason J
authors: JJ
authors: Saleem
authors: Richard L. Roudebush Veterans Affiars (VA) Medical Center, Indianapolis, IN, USA Regenstrief Institute, Inc, Indianapolis, IN, USA Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Michael
authors: M
authors: Weiner
authors: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors: Jeffrey R
authors: JR
authors: Spina
authors: Richard L. Roudebush Veterans Affiars (VA) Medical Center, Indianapolis, IN, USA Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Joanne K
authors: JK
authors: Daggy
authors: Richard L. Roudebush Veterans Affiars (VA) Medical Center, Indianapolis, IN, USA Purdue University, West Lafayette, IN, USA Regenstrief Institute, Inc, Indianapolis, IN, USA.
authors: Alan J
authors: AJ
authors: Zillich
mesh_terms: D018592:Cross-Over Studies; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D055695:Electronic Prescribing; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control; D010595:Pharmacists; D017010:Reminder Systems; D014584:User-Computer Interface
keywords: adverse drug reactions; drug interactions; informatics; medication errors; medication safety