Study: Many EHR drug alerts need not be intrusive

Using more non-interruptive drug-drug interaction alerts in electronic health records may reduce alert fatigue, according to a new study published in the Journal of the American Medical Informatics Association.

Providers bombarded with clinical decision support alerts often will ignore them. This problem is "particularly profound" with DDI alerts, which often have override rates of 90 percent, according to the study's authors.

The researchers sought to identify which DDI alerts are the most overridden and to evaluate whether certain low-priority DDI alerts could be non-interruptive to a provider's workflow to reduce alert fatigue and improve patient safety. They studied 4,077 DD pairs responsible for 158,794 alerts in a six-month time period from the alert logs of an academic medical center.

They found that a very small number of alerts accounted for a large proportion of interruptive alerting. They then asked an expert panel to assess the 49 most frequent alerts to see whether any of these alerts could be safely changed to be non-interruptive.

The panel suggested that two-thirds of the DDIs--such as iron salts with thyroid hormones or niacin with statins--could safely be changed to be non-interruptive. Moreover, those 33 DDIs accounted for more than one-third (36 percent) of all of the alerts, meaning that if they were made non-interruptive it would reduce the number of alerts generated by one-third.

The authors recommended, among other things, that a consortium be considered to maintain a list of low priority DDIs that did not warrant an interruptive alert to "reduce the number of alerts seen by a provider and thus improve alert fatigue."

Other studies have expressed concern EHRs generated too many alerts and that poorly tailored CDS would be less effective and more likely to be ignored.

To learn more:
- here's the study abstract

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