Docs disregard e-Rx alerts

By Molly Merrill
10:08 AM

A recent study finds clinicians often override the built-in medication alerts in e-prescribing systems and instead rely on their own judgments.

The study suggests clinicians find the alerts to be more annoying than helpful, and significant improvements are needed in order for e-prescribing systems to be used more effectively.

Investigators at Boston's Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center (BIDMC) led the study, which appeared in the Archives of Internal Medicine.

"Electronic prescribing clearly will improve medication safety, but its full benefit will not be realized without the development and integration of high-quality decision support systems to help clinicians better manage medication safety alerts," says the study's senior author, Saul Weingart, MD, vice president for patient safety at Dana-Farber and an internist at BIDMC.

Researchers reviewed the electronic prescriptions and associated medication safety alerts generated by 2,872 clinicians at community-based outpatient practices in Massachusetts, New Jersey, and Pennsylvania.

The clinicians submitted 3.5 million electronic prescriptions between Jan. 1 and Sept. 30, 2006. Approximately one in 15 prescription orders, or 6.6 percent, produced an alert for a drug interaction or a drug allergy. The vast majority of the 233,537 alerts (98.6 percent) were for a potential interaction with a drug a patient already takes.

Researchers found that clinicians overrode more than 90 percent of the drug interaction alerts and 77 percent of the drug allergy alerts. Even when a drug interaction alert was rated with high severity, clinicians typically dismissed those for medications commonly used in combination to treat specific diseases.

The study also suggested clinicians were less likely to accept an alert if the patient had previously been treated with the medication.

"The sheer volume of alerts generated by electronic prescribing systems stands to limit the safety benefits," says Thomas Isaac, MD, and the paper's lead author. "Too many alerts are generated for unlikely events, which could lead to alert fatigue. Better decision support programs will generate more pertinent alerts, making electronic prescribing more effective and safer."

Based on the study's findings, researchers made these recommendations to improve medication safety alerts:

  • reclassifying severity of alerts, especially those that are frequently overridden;
  • providing an option for clinicians to suppress alerts for medications a patient already has received; and
  • customizing the alerts for a clinician's specialty.