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Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system

Authors

Hsieh, T. C., Kuperman, G. J., Jaggi, T., Hojnowski-Diaz, P., Fiskio, J., Williams, D. H., Bates, D. W., Gandhi, T. K.

Journal

J Am Med Inform Assoc

Publication Date

2004 Nov-Dec

Volume

Issue

Pages

482-91

HIT Description: CPOE; Decision support More info...
Purpose of Study: assess the characteristics of over-rides of a CPOE system that produces alerts for drug allergies
Years of study: 2002
Study Design: cross sectional
Outcomes: patient safety

Summary:

Settings: Brigham and Women's Hospital inpatients
Intervention: CPOE with drug prescribing decision support
Evaluation Method: chart review
Description: Multifunctional EHR system that includes CPOE and decision support
Quality of Care and Patient Safety Outcome: alerts for drug allergy were overridden in 80% of the orders for 72% of the 1,608 patients for whom an alert was triggered. 320 patients were evaluated in more detail, revealing 19 possible adverse drug events (ADE) related to the alerted drug. Ten of these were considered significant, and 9 were serious. 16 of the ADEs were due to narcotics. None of these, however, were considered preventable, because the over-ride decision was considered justifiable. The reason for over-rides was most commonly due to outdated allergy lists.

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