title: Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department.
abstract: OBJECTIVE
  We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events.
  
  
  METHODS
  This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support.
  
  
  RESULTS
  Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden.
  
  
  CONCLUSIONS
  Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO. Electronic address: emma.genco@ucdenver.edu.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Genco
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO; VA VISN 19 Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO.
authors.forename: Jeri E
authors.initials: JE
authors.lastname: Forster
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO.
authors.forename: Hanna
authors.initials: H
authors.lastname: Flaten
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO.
authors.forename: Foster
authors.initials: F
authors.lastname: Goss
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO.
authors.forename: Kennon J
authors.initials: KJ
authors.lastname: Heard
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO.
authors.forename: Jason
authors.initials: J
authors.lastname: Hoppe
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Monte
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects*; D020000:Decision Support Systems, Clinical; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D060735:Pharmacovigilance; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid