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Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.

Authors :
Wong A
Amato MG
Seger DL
Slight SP
Beeler PE
Dykes PC
Fiskio JM
Silvers ER
Orav EJ
Eguale T
Bates DW
Source :
Journal of critical care [J Crit Care] 2017 Jun; Vol. 39, pp. 156-161. Date of Electronic Publication: 2017 Feb 20.
Publication Year :
2017

Abstract

Purpose: Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU.<br />Materials and Methods: We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that resulted from the overridden alert.<br />Results: A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n=366), with an increased risk of ADEs associated with inappropriately overridden alerts (p=0.0078).<br />Conclusions: The appropriateness of medication-related clinical decision support overrides in the ICU varied substantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.<br /> (Copyright © 2017. Published by Elsevier Inc.)

Details

Language :
English
ISSN :
1557-8615
Volume :
39
Database :
MEDLINE
Journal :
Journal of critical care
Publication Type :
Academic Journal
Accession number :
28259059
Full Text :
https://doi.org/10.1016/j.jcrc.2017.02.027