Inappropriate overriding of EHR alerts linked to 6-fold increase in adverse events

A study published in BMJ Quality & Safety examined the potential harm associated with EHR clinical decision support alert overrides in the intensive care unit.

Researchers conducted a prospective, observational study of adult patients admitted to six ICUs at one institution between July 2016 and April 2017. They studied patients with provider-overridden alerts for medication dose, drug allergy, drug-drug interaction as well as geriatric and renal alerts. Two independent reviewers measured the appropriateness of overrides.

Researchers studied a total of 2,448 overridden alerts from 712 unique patient encounters. The overall appropriateness rate for overrides was 81.6 percent.

They identified more potential and definite adverse drug events following inappropriate overrides compared to appropriate overrides — 16.5 versus 2.74 per 100 overridden alerts. They found inappropriate overrides were six times as likely to be associated with adverse drug events as compared to appropriate overrides.

"Further efforts should be targeted at improving the positive predictive value of [clinical decision support] such as by suppressing alerts that are appropriately overridden," study authors concluded.

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