Drug safety alert generation and overriding in a large Dutch university medical centre

• Published in: Pharmacoepidemiology and drug safety 2009-10, Vol.18 (10), p.941-947
• Main Authors: van der Sijs, Heleen, Mulder, Alexandra, van Gelder, Teun, Aarts, Jos, Berg, Marc, Vulto, Arnold
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - statistics & numerical data; alert; computer assisted; computerized physician order entry; Decision Support Systems, Clinical; drug interaction; Drug Interactions; Drug Overdose - prevention & control; Drug Prescriptions; drug therapy; Drug Therapy, Computer-Assisted - statistics & numerical data; Drugs; error; Hospital Units; Hospitals; Humans; Internal Medicine; Medical Order Entry Systems - statistics & numerical data; Medication Errors - prevention & control; Medication Errors - statistics & numerical data; Netherlands; overdose; override; patient safety; Pharmacy Service, Hospital - statistics & numerical data; Reminder Systems - statistics & numerical data; Retrospective Studies; Time Factors
• ISSN: 1053-8569; 1099-1557; 1099-1557
• DOI: 10.1002/pds.1800

Purpose To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre. Methods A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months. Results In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug–drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden. Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium‐level seriousness were overridden more often (55%) than low‐level (22%) or high‐level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides. Conclusions Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently‐overridden DDIs. Copyright © 2009 John Wiley & Sons, Ltd.