Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care
This article studies the downstream effects of CPOE alerts and how critical it really gets. 
This study talks about how too many CDS alerts can cause clinicians to ignore them and override critical ones. It evaluates the appropriateness of providers’ overrides and the reason why they chose to do so.
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).
After the initial screening, 68.2% (338/496) of the DDI alert overrides were considered appropriate. A detailed review of the medical charts revealed that the desired action was only carried out in 63.3% (214/338) of these cases. One hundred and thirteen different drugs, and 119 different drug-drug interactions, were found to have triggered the 496 DDI alerts.About 43.9% prescribers chosen coded reason for the overriding the DDI alerts was ‘will monitor as recommended’ followed by ‘will adjust dose as recommended’(16.9%),‘other' with a free-text provision(16.1%), ‘patient has already tolerated combination’(15.7%).
It was found that even though the alerts were modified to be better accepted by the clinicians, a lot of the them still choose to override these alerts.
There really is a fine line between helpful alerts and over-alerting. Over alerting can cause alert fatigue and lead to users ignoring critical alerts that could potentially prevent patient harm. There are still a lot of considerations regarding this issue and hoping that it would improve in the future.
- Slight SP, Seger DL, Nanji KC, et al. Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care. Berthold HK, ed. PLoS ONE. 2013;8(12):e85071. doi:10.1371/journal.pone.0085071. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873469/