CDS Leads To "Alert Fatigue"
By Katie Wike, contributing writer
Clinical decision support offers many benefits, but frequency of alerts is causing “alert fatigue”
Electronic prescription is gaining in popularity as a result of incentives offered to providers by the government. This led a team of researchers, “To characterize the override rates for medication-related CDS alerts in the outpatient setting, the reasons cited for overrides at the time of prescribing, and the appropriateness of overrides.”
The study, published in The Journal of the American Medical Informatics Association, found, “About half of CDS alerts were overridden by providers and about half of the overrides were classified as appropriate, but the likelihood of overriding an alert varied widely by alert type. Refinement of these alerts has the potential to improve the relevance of alerts and reduce alert fatigue.”
FierceHealthIT reports, “The most common CDS alerts were duplicate drug (33 percent), patient allergy (17 percent) and drug interactions (16 percent.) Alerts most likely to be overridden, however, were formulary substitutions (85 percent), age-based recommendations (79 percent), renal recommendations (78 percent), and patient allergies (77 percent).”
The study round only 53 percent of all overrides were deemed appropriate, leading researchers to conclude “that refining the alerts could improve relevance and reduce alert fatigue” and “alert fatigue and other misuses of EHRs can cause serious problems.”
FierceHealthIT notes report by the Department of Veterans Affairs' Office of Inspector General found inadequate use led to the deaths of at least two patients in its emergency department. “In one case, a nurse had inputted into the EHR the fact that the patient had an allergy to aspirin, but the physician bypassed the EHR and hand-wrote an order for an anti-inflammatory drug that is contraindicated for aspirin.
“A case study published earlier this year in the journal Pediatrics looked at the hospitalization of a 2-year-old boy whose electronic health record indicated an allergy to sulfonamide antibiotics. Clinical staff overrode more than 100 drug-allergy alerts to provide him alternate medications. But when a new drug allergy alert was added to the EHR, ‘desensitization’ caused by the ‘deluge of overrides’ meant he continued to receive an inappropriate medication, according to the case study. The confusion contributed to a worsening of the child's condition and he later died."
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