High Override Rate for Opioid Drug-allergy Interaction Alerts: Current Trends and Recommendations for Future.
This study examined trends in drug-allergy interaction (DAI) alert overrides for opioid medications - the most commonly triggered alerts in the computerized provider order entry (CPOE). We conducted an observational analysis of the DAI opioid alerts triggered over the last decade (2004-2013, n=342,338) in two large academic hospitals in Boston (United States). We found an increasing rate of DAI alert overrides culminating in 89.7% in 2013. Allergic reactions included a high proportion (38.2%) of non-immune mediated opioid reactions (e.g. gastrointestinal upset). The DAI alert override rate was high for immune mediated (88.6%) and life threatening reactions (87.8%). Exact allergy-medication matches were overridden less frequently (about 70%) compared to non-exact matches within allergy groups (over 90%). About one-third of the alert override reasons pointed to irrelevant alerts (i.e."Patient has tolerated the medication before") and 44.9% were unknown. Those findings warrant further investigation into providers' reasons for high override rate. User interfaces should evolve to enable less interruptive and more accurate alerts to decrease alert fatigue.
Brigham and Women's Hospital, Boston, MA, USA.
Maxim
M
Topaz
Brigham and Women's Hospital, Boston, MA, USA.
Diane L
DL
Seger
Clinical Informatics, Partners eCare, Partners Healthcare System, Boston, MA, USA.
Kenneth
K
Lai
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
Paige G
PG
Wickner
University of Colorado, Department of Emergency Medicine, Aurora, CO, USA.
Foster
F
Goss
Brigham and Women's Hospital, Boston, MA, USA.
Neil
N
Dhopeshwarkar
Brigham and Women's Hospital, Boston, MA, USA.
Frank
F
Chang
Brigham and Women's Hospital, Boston, MA, USA.
David W
DW
Bates
Brigham and Women's Hospital, Boston, MA, USA.
Li
L
Zhou
D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D056902:Clinical Alarms / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014584:User-Computer Interface; D014600:Utilization Review