Healthc Inform Res.  2014 Oct;20(4):280-287. 10.4258/hir.2014.20.4.280.

Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department

• Ahn EK
• Cho SY
• Shin D
• Jang C
• Park RW

• KMID: 2166803
• DOI: http://doi.org/10.4258/hir.2014.20.4.280

Abstract

OBJECTIVES
To reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments.
METHODS
A retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs.
RESULTS
Among 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%).
CONCLUSIONS
We confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.

Keyword

Contraindications; Drug Interactions; Clinical Decision Support Systems; Hospital Admitting Department

MeSH Terms

Admitting Department, Hospital*
Adult
Antirheumatic Agents
Decision Support Systems, Clinical
Drug Interactions
Electronic Health Records
Emergency Service, Hospital
Humans
Observational Study
Patients' Rooms
Prescriptions
Retrospective Studies
Antirheumatic Agents

Figure

• 

  Figure 1 Flowchart showing prescriptions and observations included in the study. All prescriptions in the emergency department (ED) and general ward (GW) from September 1, 2009 to July 31, 2013, were included (n = 39,429,497; number of observations = 570,663). Multiple visits or admissions of a patient were counted separately. Thus, the observations may include the same patient more than once. We excluded eye drops, re-hydration solutions, and topical medications, patients who only visited the out-patient department (OPD) or were admitted to the intensive care unit (ICU), patients with no demographic information, and patients hospitalized for over 365 days. There were 1,693,460 prescriptions in the ED (197,087 observations) and 13,087,059 prescriptions in the GW (146,056 observations).

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