AHRQ Study: EHR Drug Allergy Safety Warnings Need Urgent Improvement

An urgent need exists to improve the accuracy and relevance of drug allergy safety alerts issued through computerized provider order entry systems, according to an AHRQ study. The improvements are needed to reduce the rate of alert overrides by clinicians who may be subject to “alert fatigue,” or becoming desensitized to safety alerts by either ignoring or failing to respond appropriately to them. Based on more than 611,000 drug allergy alert records from 2004 to 2013 at two large Boston academic hospitals, the study found that alerts for two serious reactions were overridden about three-quarters of the time. “Rising Drug Allergy Alert Overrides in Electronic Health Records: An Observational Retrospective Study of a Decade of Experience” and abstract were published in the Journal of the American Medical Informatics Association.

2015 Nov 17. pii: ocv143. doi: 10.1093/jamia/ocv143. [Epub ahead of print]

Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decadeof experience.

Topaz M1, Seger DL2, Slight SP3, Goss F4, Lai K5, Wickner PG5, Blumenthal K6, Dhopeshwarkar N5, Chang F5, Bates DW7, Zhou L8.

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Abstract

OBJECTIVE:

There have been growing concerns about the impact of drug allergy alerts on patient safety and provider alert fatigue. The authors aimed to explore the common drug allergy alerts over the last 10 years and the reasons why providers tend to override these alerts.

DESIGN:

Retrospective observational cross-sectional study (2004-2013).

MATERIALS AND METHODS:

Drug allergy alert data (n = 611,192) were collected from two large academic hospitals in Boston, MA (USA).

RESULTS:

Overall, the authors found an increase in the rate of drug allergy alert overrides, from 83.3% in 2004 to 87.6% in 2013 (P < .001). Alarmingly, alerts for immune mediated and life threatening reactions with definite allergen and prescribed medication matches were overridden 72.8% and 74.1% of the time, respectively. However, providers were less likely to override these alerts compared to possible (cross-sensitivity) or probable (allergen group) matches (P < .001). The most common drug allergy alerts were triggered by allergies to narcotics (48%) and other analgesics (6%), antibiotics (10%), and statins (2%). Only slightly more than one-third of the reactions (34.2%) were potentially immune mediated. Finally, more than half of the overrides reasons pointed to irrelevant alerts (i.e., patient has tolerated the medication before, 50.9%) and providers were significantly more likely to override repeated alerts (89.7%) rather than first time alerts (77.4%, P < .001).

DISCUSSION AND CONCLUSIONS:

These findings underline the urgent need for more efforts to provide more accurate and relevant drug allergyalerts to help reduce alert override rates and improve alert fatigue.

Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the US.