Overrides of Medication Alerts in Ambulatory Care
Overrides of Medication Alerts in Ambulatory Care
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DOI：
10.1001/archinternmed.2008.551
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发表时间：
2009-02-09
影响因子：
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通讯作者：
Weingart, Saul N.
中科院分区：
文献类型：
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作者：
Isaac, Thomas;Weissman, Joel S.;Weingart, Saul N.
背景：具有决策支持的电子处方系统可以通过提供药物过敏和药物相互作用警报来提高门诊护理患者的安全性。然而，初步研究表明，临床医生无视这些警报中的大多数。方法：从2006年1月1日至2006年9月30日，我们对马萨诸塞州、新泽西州和宾夕法尼亚州2872名临床医生产生的232337份药物安全警报进行了回顾性分析，这些临床医生使用了通用的电子处方系统。我们使用多变量技术来检查与警觉性接受相关的因素。结果：共有6.6%的电子处方尝试产生警报。临床医生接受了9.2%的药物相互作用警报和23.0%的过敏警报。高严重性相互作用占大多数警报（61.6%）；临床医生接受高严重性警报的频率略高于接受中度或低严重性相互作用警报的频率（分别为10.4%、7.3%和7.1%;P < 0.001）。根据相互作用药物的类别，临床医生接受了2.2%至43.1%的高严重性相互作用警报。在多变量分析中，我们发现不同专业的临床医生对警报接受度没有差异（P = .16）。如果患者之前接受过警告药物，临床医生更不可能接受药物相互作用警告（优势比，0.03；95%可信区间，0.03-0.03）。结论：临床医生忽略了大多数药物警告，这表明目前的药物安全警告可能不足以保护患者安全。
Background: Electronic prescribing systems with decision support may improve patient safety in ambulatory care by offering drug allergy and drug interaction alerts. However, preliminary studies show that clinicians override most of these alerts.Methods: We performed a retrospective analysis of 233 537 medication safety alerts generated by 2872 clinicians in Massachusetts, New Jersey, and Pennsylvania who used a common electronic prescribing system from January 1, 2006, through September 30, 2006. We used multivariate techniques to examine factors associated with alert acceptance.Results: A total of 6.6% of electronic prescription attempts generated alerts. Clinicians accepted 9.2% of drug interaction alerts and 23.0% of allergy alerts. High-severity interactions accounted for most alerts (61.6%); clinicians accepted high-severity alerts slightly more often than moderate- or low-severity interaction alerts (10.4%, 7.3%, and 7.1%, respectively; P < .001). Clinicians accepted 2.2% to 43.1% of high-severity interaction alerts, depending on the classes of interacting medications. In multivariable analyses, we found no difference in alert acceptance among clinicians of different specialties (P = .16). Clinicians were less likely to accept a drug interaction alert if the patient had previously received the alerted medication (odds ratio, 0.03; 95% confidence interval, 0.03-0.03).Conclusion: Clinicians override most medication alerts, suggesting that current medication safety alerts may be inadequate to protect patient safety.