Drug safety alert generation and overriding in a large Dutch university medical centre. van der Sijs, H., Mulder, A., van Gelder, T., Aarts, J., Berg, M., & Vulto, A. Pharmacoepidemiology and drug safety, 18(10):941–947, October, 2009. doi abstract bibtex 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.
@article{van_der_sijs_drug_2009,
title = {Drug safety alert generation and overriding in a large {Dutch} university medical centre},
volume = {18},
issn = {1099-1557},
doi = {10.1002/pds.1800},
abstract = {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.},
language = {eng},
number = {10},
journal = {Pharmacoepidemiology and drug safety},
author = {van der Sijs, Heleen and Mulder, Alexandra and van Gelder, Teun and Aarts, Jos and Berg, Marc and Vulto, Arnold},
month = oct,
year = {2009},
pmid = {19579216},
keywords = {Academic Medical Centers, Decision Support Systems, Clinical, Drug Interactions, Drug Overdose, Drug Prescriptions, Drug Therapy, Computer-Assisted, Hospital Units, Humans, Internal Medicine, Medical Order Entry Systems, Medication Errors, Netherlands, Pharmacy Service, Hospital, Reminder Systems, Retrospective Studies, Time Factors},
pages = {941--947}
}
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{"_id":"SLZAxaoKkJuLEPsDR","bibbaseid":"vandersijs-mulder-vangelder-aarts-berg-vulto-drugsafetyalertgenerationandoverridinginalargedutchuniversitymedicalcentre-2009","downloads":0,"creationDate":"2018-12-05T13:23:20.097Z","title":"Drug safety alert generation and overriding in a large Dutch university medical centre","author_short":["van der Sijs, H.","Mulder, A.","van Gelder, T.","Aarts, J.","Berg, M.","Vulto, A."],"year":2009,"bibtype":"article","biburl":"https://bibbase.org/zotero/emmanuel.chazard","bibdata":{"bibtype":"article","type":"article","title":"Drug safety alert generation and overriding in a large Dutch university medical centre","volume":"18","issn":"1099-1557","doi":"10.1002/pds.1800","abstract":"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.","language":"eng","number":"10","journal":"Pharmacoepidemiology and drug safety","author":[{"propositions":["van","der"],"lastnames":["Sijs"],"firstnames":["Heleen"],"suffixes":[]},{"propositions":[],"lastnames":["Mulder"],"firstnames":["Alexandra"],"suffixes":[]},{"propositions":["van"],"lastnames":["Gelder"],"firstnames":["Teun"],"suffixes":[]},{"propositions":[],"lastnames":["Aarts"],"firstnames":["Jos"],"suffixes":[]},{"propositions":[],"lastnames":["Berg"],"firstnames":["Marc"],"suffixes":[]},{"propositions":[],"lastnames":["Vulto"],"firstnames":["Arnold"],"suffixes":[]}],"month":"October","year":"2009","pmid":"19579216","keywords":"Academic Medical Centers, Decision Support Systems, Clinical, Drug Interactions, Drug Overdose, Drug Prescriptions, Drug Therapy, Computer-Assisted, Hospital Units, Humans, Internal Medicine, Medical Order Entry Systems, Medication Errors, Netherlands, Pharmacy Service, Hospital, Reminder Systems, Retrospective Studies, Time Factors","pages":"941–947","bibtex":"@article{van_der_sijs_drug_2009,\n\ttitle = {Drug safety alert generation and overriding in a large {Dutch} university medical centre},\n\tvolume = {18},\n\tissn = {1099-1557},\n\tdoi = {10.1002/pds.1800},\n\tabstract = {PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre.\nMETHODS: 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.\nRESULTS: 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.\nCONCLUSIONS: 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.},\n\tlanguage = {eng},\n\tnumber = {10},\n\tjournal = {Pharmacoepidemiology and drug safety},\n\tauthor = {van der Sijs, Heleen and Mulder, Alexandra and van Gelder, Teun and Aarts, Jos and Berg, Marc and Vulto, Arnold},\n\tmonth = oct,\n\tyear = {2009},\n\tpmid = {19579216},\n\tkeywords = {Academic Medical Centers, Decision Support Systems, Clinical, Drug Interactions, Drug Overdose, Drug Prescriptions, Drug Therapy, Computer-Assisted, Hospital Units, Humans, Internal Medicine, Medical Order Entry Systems, Medication Errors, Netherlands, Pharmacy Service, Hospital, Reminder Systems, Retrospective Studies, Time Factors},\n\tpages = {941--947}\n}\n\n","author_short":["van der Sijs, H.","Mulder, A.","van Gelder, T.","Aarts, J.","Berg, M.","Vulto, A."],"key":"van_der_sijs_drug_2009","id":"van_der_sijs_drug_2009","bibbaseid":"vandersijs-mulder-vangelder-aarts-berg-vulto-drugsafetyalertgenerationandoverridinginalargedutchuniversitymedicalcentre-2009","role":"author","urls":{},"keyword":["Academic Medical Centers","Decision Support Systems","Clinical","Drug Interactions","Drug Overdose","Drug Prescriptions","Drug Therapy","Computer-Assisted","Hospital Units","Humans","Internal Medicine","Medical Order Entry Systems","Medication Errors","Netherlands","Pharmacy Service","Hospital","Reminder Systems","Retrospective Studies","Time Factors"],"downloads":0},"search_terms":["drug","safety","alert","generation","overriding","large","dutch","university","medical","centre","van der sijs","mulder","van gelder","aarts","berg","vulto"],"keywords":["academic medical centers","decision support systems","clinical","drug interactions","drug overdose","drug prescriptions","drug therapy","computer-assisted","hospital units","humans","internal medicine","medical order entry systems","medication errors","netherlands","pharmacy service","hospital","reminder systems","retrospective studies","time factors"],"authorIDs":[],"dataSources":["XiRGowmyYWQpwjiC9"]}