TY - JOUR
T1 - Appropriateness of overridden alerts in computerized physician order entry
T2 - Systematic review
AU - Poly, Tahmina Nasrin
AU - Islam, Md Mohaimenul
AU - Yang, Hsuan Chia
AU - Li, Yu Chuan Jack
N1 - Funding Information:
We would like to thank our colleague who is a native English speaker for editing our manuscript. This research is funded in part by the Ministry of Education (MOE) under grants MOE 108-6604-001-400 and DP2-109-21121-01-A-01, and by the Ministry of Science and Technology (MOST) under grants MOST 108-2823-8-038-002 and 109-2222-E-038-002-MY2.
Publisher Copyright:
© 2020 Tahmina Nasrin Poly, Md.Mohaimenul Islam, Hsuan-Chia Yang, Yu-Chuan (Jack) Li.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - Background: The clinical decision support system (CDSS) has become an indispensable tool for reducing medication errors and adverse drug events. However, numerous studies have reported that CDSS alerts are often overridden. The increase in override rates has raised questions about the appropriateness of CDSS application along with concerns about patient safety and quality of care. Objective: The aim of this study was to conduct a systematic review to examine the override rate, the reasons for the alert override at the time of prescribing, and evaluate the appropriateness of overrides. Methods: We searched electronic databases, including Google Scholar, PubMed, Embase, Scopus, and Web of Science, without language restrictions between January 1, 2000 and March 31, 2019. Two authors independently extracted data and crosschecked the extraction to avoid errors. The quality of the included studies was examined following Cochrane guidelines. Results: We included 23 articles in our systematic review. The range of average override alerts was 46.2%-96.2%. An average of 29.4%-100% of the overrides alerts were classified as appropriate, and the rate of appropriateness varied according to the alert type (drug-allergy interaction 63.4%-100%, drug-drug interaction 0%-95%, dose 43.9%-88.8%, geriatric 14.3%-57%, renal 27%-87.5%). The interrater reliability for the assessment of override alerts appropriateness was excellent (kappa=0.79-0.97). The most common reasons given for the override were "will monitor"and "patients have tolerated before."Conclusions: The findings of our study show that alert override rates are high, and certain categories of overrides such as drug-drug interaction, renal, and geriatric were classified as inappropriate. Nevertheless, large proportions of drug duplication, drug-allergy, and formulary alerts were appropriate, suggesting that these groups of alerts can be primary targets to revise and update the system for reducing alert fatigue. Future efforts should also focus on optimizing alert types, providing clear information, and explaining the rationale of the alert so that essential alerts are not inappropriately overridden.
AB - Background: The clinical decision support system (CDSS) has become an indispensable tool for reducing medication errors and adverse drug events. However, numerous studies have reported that CDSS alerts are often overridden. The increase in override rates has raised questions about the appropriateness of CDSS application along with concerns about patient safety and quality of care. Objective: The aim of this study was to conduct a systematic review to examine the override rate, the reasons for the alert override at the time of prescribing, and evaluate the appropriateness of overrides. Methods: We searched electronic databases, including Google Scholar, PubMed, Embase, Scopus, and Web of Science, without language restrictions between January 1, 2000 and March 31, 2019. Two authors independently extracted data and crosschecked the extraction to avoid errors. The quality of the included studies was examined following Cochrane guidelines. Results: We included 23 articles in our systematic review. The range of average override alerts was 46.2%-96.2%. An average of 29.4%-100% of the overrides alerts were classified as appropriate, and the rate of appropriateness varied according to the alert type (drug-allergy interaction 63.4%-100%, drug-drug interaction 0%-95%, dose 43.9%-88.8%, geriatric 14.3%-57%, renal 27%-87.5%). The interrater reliability for the assessment of override alerts appropriateness was excellent (kappa=0.79-0.97). The most common reasons given for the override were "will monitor"and "patients have tolerated before."Conclusions: The findings of our study show that alert override rates are high, and certain categories of overrides such as drug-drug interaction, renal, and geriatric were classified as inappropriate. Nevertheless, large proportions of drug duplication, drug-allergy, and formulary alerts were appropriate, suggesting that these groups of alerts can be primary targets to revise and update the system for reducing alert fatigue. Future efforts should also focus on optimizing alert types, providing clear information, and explaining the rationale of the alert so that essential alerts are not inappropriately overridden.
KW - Alert fatigue
KW - Clinical decision system
KW - Computerized physician order entry
KW - Override
KW - Patient safety
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UR - http://www.scopus.com/inward/citedby.url?scp=85097463133&partnerID=8YFLogxK
U2 - 10.2196/15653
DO - 10.2196/15653
M3 - Review article
AN - SCOPUS:85097463133
SN - 2291-9694
VL - 8
JO - JMIR medical informatics
JF - JMIR medical informatics
IS - 7
M1 - e15653
ER -