Physicians' Decisions to Override Computerized Drug Alerts in Primary Care

Abstract

Background: Although computerized physician order entry reduces medication errors among inpatients, little is known about the use of this system in primary care. Methods: We calculated the override rate among 3481 consecutivealertsgeneratedat5adultprimarycareprac- tices that use a common computerized physician order entry system for prescription writing. For detailed re- view, we selected a random sample of 67 alerts in which physicians did not prescribe an alerted medication and 122alertsthatresultedinawrittenprescription.Weiden- tified factors associated with the physicians' decisions to override a medication alert, and determined whether an adverse drug event (ADE) occurred. Results:Physicians overrode 91.2% of drug allergy and 89.4%ofhigh-severitydruginteractionalerts.Inthemul- tivariableanalysisusingthemedicalchartreviewsample (n=189),physicianswerelesslikelytoprescribeanalerted medicationiftheprescriberwasahouseofficer(oddsra- tio (OR), 0.26; 95% confidence interval (CI), 0.08- 0.84)andifthepatienthadmanydrugallergies(OR,0.70; 95% CI, 0.53-0.93). They were more likely to override alertsforrenewalscomparedwithnewprescriptions(OR, 17.74; 95% CI, 5.60-56.18). We found no ADEs in cases where physicians observed the alert and 3 ADEs among patients with alert overrides, a nonsignificant difference (P=.55). Physician reviewers judged that 36.5% of the alerts were inappropriate. Conclusions: Few physicians changed their prescrip- tioninresponsetoadrugallergyorinteractionalert,and there were few ADEs, suggesting that the threshold for alerting was set too low. Computerized physician order entrysystemsshouldsuppressalertsforrenewalsofmedi- cation combinations that patients currently tolerate. Arch Intern Med. 2003;163:2625-2631