George Robinson, RPh, senior product manager, First Databank.
Approximately $20 billion is lost annually in the United States because of medication errors, with the average hospitalized patient subject to at least one medication mistake per day.Alert fatigue is often cited as a reason for these errors—even though alerts generated by clinical decision support (CDS) systems call attention to important information (such as potential drug interactions), excessive alerts wear clinicians down, resulting in boy-who-cries-wolf scenarios. The result: clinicians instinctively override the alerts instead of implementing an override monitoring plan.
Consider the following:
- In 2009, researchers at the Boston-based Beth Israel Deaconess Medical Center and the Dana-Farber Cancer Institute looked at the safety alerts generated by 2,872 clinicians through 3.5 million electronic prescriptions over a nine-month period. Of the 233,537 alerts, 98 percent were drug-drug interaction issues, and more than 90 percent were overridden.
- A more recent 2013 study, published in the Journal of the American Medical Informatics Association, showed improved override rates with only about half of alerts overridden by providers, with half of those overrides classified as appropriate. Authors concluded that further refinement of these alerts could improve relevance and reduce alert fatigue.
A Driver in Need of a Clearer View
The afore-mentioned studies conclude that clinicians are indeed overriding medication alerts at alarming rates. Although the industry has made significant progress in addressing alert fatigue during the time the data from these studies was being analyzed, these studies clearly support what most healthcare professionals already suspect: The practice of ignoring and overriding medication alerts is widespread and can potentially lead to undesirable consequences.