Overriding of drug safety alerts in computerized physician order entry

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This is a review of Helen Van Der Sus et al's 2006 article, Overriding of Drug Safety Alerts in Computerized Physician Order Entry. J Am Med Inform Assoc. 2006; 13: 138-147. [1]


Many computerized physician order entry (CPOE) systems have integrated clinical decision support (CDS) with the potential to reduce medication errors and improve patient safety. The article looks at how physicians handle safety alerts when medication orders are processed. The review focuses mainly on the conceptual analysis of the determinants of overriding drug safety alerts.

Research Questions

The authors posted the following questions: “How often and in what situations are safety alerts overridden? Why do physicians override them? What effects ensue? What understanding of alert overrides can lead to improved alerting systems?”


The authors searched for literature on publications involving CPOE on MEDLINE and EMBASE databases from January 1980 to December 2004. They examined and identified publications addressing overriding of drug safety alerts during medication order processing. Seventeen publications on overriding safety alert in CPOE were selected and nine provided quantitative information on overriding.


Safety alerts are overridden 49% to 96% of cases with lower override rates for drug interactions and contraindications. Though not completely confirmed, some studies showed that low-level alerts appeared to be overridden more often than high-level alerts. Drug renewals, drug interactions with topical drugs and poorly defined drug allergies were among those with high override rates. Adverse events were observed in 2.3% to 6% of overridden alerts.

Publications on Overriding Drug Safety Alerts During the Order Entry Process


CDS when integrated with CPOE systems improve patient safety by reducing medication errors through safety alerts. Alerts, depending on whether they are justified or unjustified, low or high specificity and sensitivity, could cause adverse events when overridden. Too many unnecessary safety alerts will cause alert fatigue and increase overrides. If poorly designed, decision support in CPOE can compromise patient safety. Improving alerting will decrease overriding and improve safety. Alerts need to be monitored, should have high specificity and sensitivity, do not unnecessarily interfere with workflow, and should have clear information.

Related Articles on Drug Safety Alerts

PLoS One. 2013; ;8(12):e85071. [1]


  1. 1.0 1.1 Helen Van Der Sus et al. Overriding of Drug Safety Alerts in Computerized Physician Order Entry. J Am Med Inform Assoc. 2006; 13: 138-147. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447540/