TY - JOUR
KW - Academic Medical Centers/statistics & numerical data
KW - Decision Support Systems, Clinical
KW - Drug Interactions
KW - Drug Prescriptions
KW - Drug Therapy, Computer-Assisted/statistics & numerical data
KW - Hospital Units
KW - Humans
KW - internal medicine
KW - Medical Order Entry Systems/statistics & numerical data
KW - Medication Errors/prevention & control/statistics & numerical data
KW - Netherlands
KW - Overdose/prevention & control
KW - Pharmacy Service, Hospital/statistics & numerical data
KW - Reminder Systems/statistics & numerical data
KW - Retrospective Studies
KW - Time Factors
AU - H. van der Sijs
AU - A. Mulder
AU - T. van Gelder
AU - J. Aarts
AU - M. Berg
AU - A. Vulto
A1 - 
AB - PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre. METHODS: A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months. RESULTS: In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug-drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium-level seriousness were overridden more often (55%) than low-level (22%) or high-level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides. CONCLUSIONS: Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.
BT - Pharmacoepidemiology and drug safety
C5 - HIT & Telehealth
CP - 10
CY - England
DO - 10.1002/pds.1800
IS - 10
JF - Pharmacoepidemiology and drug safety
N2 - PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre. METHODS: A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months. RESULTS: In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug-drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium-level seriousness were overridden more often (55%) than low-level (22%) or high-level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides. CONCLUSIONS: Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.
PB - John Wiley & Sons, Ltd
PP - England
PY - 2009
SN - 1099-1557; 1053-8569
SP - 941
EP - 947
EP - 
T1 - Drug safety alert generation and overriding in a large Dutch university medical centre
T2 - Pharmacoepidemiology and drug safety
TI - Drug safety alert generation and overriding in a large Dutch university medical centre
U1 - HIT & Telehealth
U3 - 10.1002/pds.1800
VL - 18
VO - 1099-1557; 1053-8569
Y1 - 2009
ER -