Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care
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{"title"=>"Are we heeding the warning signs? Examining providers' overrides of computerized drug-drug interaction alerts in primary care", "type"=>"journal", "authors"=>[{"first_name"=>"Sarah P.", "last_name"=>"Slight", "scopus_author_id"=>"55523613800"}, {"first_name"=>"Diane L.", "last_name"=>"Seger", "scopus_author_id"=>"7006027933"}, {"first_name"=>"Karen C.", "last_name"=>"Nanji", "scopus_author_id"=>"35332740100"}, {"first_name"=>"Insook", "last_name"=>"Cho", "scopus_author_id"=>"55858319500"}, {"first_name"=>"Nivethietha", "last_name"=>"Maniam", "scopus_author_id"=>"56025712100"}, {"first_name"=>"Patricia C.", "last_name"=>"Dykes", "scopus_author_id"=>"7007156158"}, {"first_name"=>"David W.", "last_name"=>"Bates", "scopus_author_id"=>"36037038800"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "isbn"=>"1932-6203", "pmid"=>"24386447", "scopus"=>"2-s2.0-84893474216", "doi"=>"10.1371/journal.pone.0085071", "sgr"=>"84893474216", "pui"=>"372294789"}, "id"=>"8138b085-ab1f-3792-a4c4-adf3fad11f3a", "abstract"=>"<sec sec-type=\"headed\"><title>Background</title><p>Health IT can play a major role in improving patient safety. Computerized physician order entry with decision support can alert providers to potential prescribing errors. However, too many alerts can result in providers ignoring and overriding clinically important ones. </p></sec><sec sec-type=\"headed\"><title>Objective</title><p>To evaluate the appropriateness of providers’ drug-drug interaction (DDI) alert overrides, the reasons why they chose to override these alerts, and what actions they took as a consequence of the alert. </p></sec><sec sec-type=\"headed\"><title>Design</title><p>A cross-sectional, observational study of DDI alerts generated over a three-year period between January 1st, 2009, and December 31st, 2011.</p></sec><sec sec-type=\"headed\"><title>Setting</title><p>Primary care practices affiliated with two Harvard teaching hospitals. The DDI alerts were screened to minimize the number of clinically unimportant warnings.</p></sec><sec sec-type=\"headed\"><title>Participants</title><p>A total of 24,849 DDI alerts were generated in the study period, with 40% accepted. The top 62 providers with the highest override rate were identified and eight overrides randomly selected for each (a total of 496 alert overrides for 438 patients, 3.3% of the sample).</p></sec><sec sec-type=\"headed\"><title>Results</title><p>Overall, 68.2% (338/496) of the DDI alert overrides were considered appropriate. Among inappropriate overrides, the therapeutic combinations put patients at increased risk of several specific conditions including: serotonin syndrome (21.5%, n=34), cardiotoxicity (16.5%, n=26), or sharp falls in blood pressure or significant hypotension (28.5%, n=45). A small number of drugs and DDIs accounted for a disproportionate share of alert overrides. Of the 121 appropriate alert overrides where the provider indicated they would “monitor as recommended”, a detailed chart review revealed that only 35.5% (n=43) actually did. Providers sometimes reported that patients had already taken interacting medications together (15.7%, n=78), despite no evidence to confirm this. </p></sec><sec sec-type=\"headed\"><title>Conclusions and Relevance</title><p>We found that providers continue to override important and useful alerts that are likely to cause serious patient injuries, even when relatively few false positive alerts are displayed. </p></sec>", "link"=>"http://www.mendeley.com/research/we-heeding-warning-signs-examining-providers-overrides-computerized-drugdrug-interaction-alerts-prim", "reader_count"=>74, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Librarian"=>1, "Researcher"=>19, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>9, "Student > Master"=>13, "Other"=>5, "Student > Bachelor"=>5}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Librarian"=>1, "Researcher"=>19, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>9, "Student > Master"=>13, "Other"=>5, "Student > Bachelor"=>5}, "reader_count_by_subject_area"=>{"Engineering"=>1, "Unspecified"=>2, "Nursing and Health Professions"=>3, "Biochemistry, Genetics and Molecular Biology"=>1, "Materials Science"=>1, "Medicine and Dentistry"=>37, "Agricultural and Biological Sciences"=>6, "Pharmacology, Toxicology and Pharmaceutical Science"=>7, "Psychology"=>2, "Social Sciences"=>4, "Computer Science"=>10}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>37}, "Social Sciences"=>{"Social Sciences"=>4}, "Psychology"=>{"Psychology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>6}, "Computer Science"=>{"Computer Science"=>10}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>7}}, "reader_count_by_country"=>{"Korea (South)"=>1, "United States"=>3, "Brazil"=>1, "Germany"=>1}, "group_count"=>11}

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Relative Metric

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