title: Physicians' responses to computerized drug interaction alerts with password overrides.
abstract: BACKGROUND
  Although evidence has suggested that computerized drug-drug interaction alert systems may reduce the occurrence of drug-drug interactions, the numerous reminders and alerts generated by such systems could represent an excessive burden for clinicians, resulting in a high override rate of not only unimportant, but also important alerts.
  
  
  METHODS
  We analyzed physicians' responses to alerts of relative contraindications and contraindications for coadministration in a computerized drug-drug interaction alert system at Hokkaido University Hospital. In this system, the physician must enter a password to override an alert and continue an order. All of the drug-drug interaction alerts generated between December 2011 and November 2012 at Hokkaido University Hospital were included in this study.
  
  
  RESULTS
  The system generated a total of 170 alerts of relative contraindications and contraindication for coadministration; 59 (34.7 %) of the corresponding orders were cancelled after the alert was accepted, and 111 (65.3 %) were overridden. The most frequent contraindication alert was for the combination of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors and fibrates. No incidents involving drug-drug interactions were reported among patients who were prescribed contraindicated drug pairs after an override.
  
  
  CONCLUSIONS
  Although computerized drug-drug interaction alert systems that require password overrides appear useful for promoting medication safety, having to enter passwords to override alerts may represent an excessive burden for the prescribing physician. Therefore, both patient safety and physicians' workloads should be taken into consideration in future designs of computerized drug-drug interaction alert systems.
authors: Division of Hospital Safety Management, Hokkaido University Hospital, Sapporo, Japan. nasuhara@med.hokudai.ac.jp.
authors: Yasuyuki
authors: Y
authors: Nasuhara
authors: Department of Regulatory Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Ken
authors: K
authors: Sakushima
authors: Division of Medical Information Planning, Hokkaido University Hospital, Sapporo, Japan.
authors: Akira
authors: A
authors: Endoh
authors: Division of Medical Information Planning, Hokkaido University Hospital, Sapporo, Japan.
authors: Reona
authors: R
authors: Umeki
authors: Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.
authors: Hiromitsu
authors: H
authors: Oki
authors: Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.
authors: Takehiro
authors: T
authors: Yamada
authors: Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.|Laboratory of Clinical Pharmaceutics and Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan.
authors: Ken
authors: K
authors: Iseki
authors: Division of Hospital Safety Management, Hokkaido University Hospital, Sapporo, Japan.
authors: Makoto
authors: M
authors: Ishikawa
mesh_terms: D000328:Adult; D004347:Drug Interactions; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards*; D010820:Physicians