Purpose: Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU.
Materials And Methods: We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that resulted from the overridden alert.
Results: A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n=366), with an increased risk of ADEs associated with inappropriately overridden alerts (p=0.0078).
Conclusions: The appropriateness of medication-related clinical decision support overrides in the ICU varied substantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jcrc.2017.02.027 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Impact of a Clinical Decision Support System on Computed Tomographic Pulmonary Angiogram Yield and Utilization in Hospitalized Patients.
J Am Coll Radiol
December 2024
Harvard Medical School, Boston, MA; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA. Electronic address:
Objective: To determine whether point-of-order clinical decision support (CDS) based on the Wells Criteria improves CT pulmonary angiogram (CTPA) yield and utilization in hospitalized patients in an enterprise-wide health system and identify yield-related factors.
Methods: This retrospective IRB-approved cross-sectional study in an urban, multi-institution health system included hospitalized patients undergoing CTPA 12 months before and after CDS implementation (entire cohort). Chi-square test was used to compare PE yield in patients in whom providers overrode vs.
Evaluation of barcode-assisted medication preparation technology for liquid medication doses.
Am J Health Syst Pharm
November 2024
Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX, USA.
Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
View Article and Find Full Text PDFPreventing Overrides of Severe Drug Allergy Alerts Initiative: an Implemented System Upgrade.
J Med Syst
October 2024
King Abdulaziz Medical City, Ministry of NG-HA, KSAU-HS, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
Administering medications to patients with documented drug hypersensitivity reactions (DHR) poses a significant risk for adverse events, ranging from mild reactions to life-threatening incidents. Electronic healthcare systems have revolutionized the modern clinical decision-making process, with built in warnings. However, as these alerts become a routine part of healthcare provider's workflow, alert fatigue becomes a challenge.
View Article and Find Full Text PDFIntroduction: A risk factor for a potentially fatal ventricular arrhythmia Torsade de Pointes is a prolongation in the heart rate-corrected QT interval (QTc) ≥ 500 milliseconds (ms) or an increase of ≥ 60 ms from a patient's baseline value, which can cause sudden cardiac death. The Tisdale risk score calculator uses clinical variables to predict which hospitalized patients are at the highest risk for QTc prolongation.
Objective: To determine the rate of overridden QTc drug-drug interaction (DDI)-related clinical decision support (CDS) alerts per patient admission and the prevalence by Tisdale risk score category of these overridden alerts.
Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis.
Health Informatics J
June 2024
Bridge Laboratory, Technological Center, Federal University of Santa Catarina, Florianópolis, Brazil.
Primary studies have demonstrated that despite being useful, most of the drug-drug interaction (DDI) alerts generated by clinical decision support systems are overridden by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians. The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!