Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system
Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system
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DOI：
10.1197/jamia.m1556
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发表时间：
2004-11-01
影响因子：
6.4
通讯作者：
Gandhi, TK
中科院分区：
文献类型：
--
作者：
Hsieh, TC;Kuperman, GJ;Gandhi, TK
目的：本研究的目的是确定药物过敏警报超控的特征，评估它们导致可预防药物不良事件 (ADE) 的频率，并提出改进过敏警报系统的方法。设计：对一家大型学术医院 3 个月期间（2002 年 8 月至 10 月）内发生的所有过敏警报的分层随机子集进行图表审查。测量：测量的因素是触发警报的药物/过敏组合、特定超控的频率结果：1,150 名患者的 7,761 个警报中共有 6,182 个警报 (80%) 被忽略。在此示例中，只有 10% 的警报是由订购的药物与列出的过敏症完全匹配而触发的。医生推翻警报的最常见原因是“意识到/愿意监测”(55%)、“患者没有这种过敏/耐受”(33%) 和“患者已经服用”(10%)。在图表审查的 320 名患者（1,150 名患者中的 28%）的分层随机子集中，19 名患者（6%）经历了归因于覆盖药物的 ADE；其中，9 例（47%）情况严重。没有任何 ADE 被认为是可以预防的，因为这些超控被认为在临床上是合理的。患者过敏清单的完整性差异很大，并且在纸质图表和 CPOE 系统中普遍较低。结论：药物过敏警报的忽略很常见，大约二十分之一导致 ADE，但所有导致 ADE 的忽略在临床上似乎都是合理的。警报覆盖率较高是由于频繁的不精确匹配警报和过敏列表的不频繁更新。基于这些发现，我们提出了具体建议，以提高警报的特异性，从而提高药物过敏警报系统的临床实用性。
Objective: The aim of this study was to determine characteristics of drug allergy alert overrides, assess how often they lead to preventable adverse drug events (ADEs), and suggest methods for improving the allergy-alerting system.Design: Chart review was performed on a stratified random subset of all allergy alerts occurring during a 3-month period (August through October 2002) at a large academic hospital.Measurements: Factors that were measured were drug/allergy combinations that triggered alerts, frequency of specific override reasons, characteristics of ADEs, and completeness of allergy documentation.Results: A total of 6,182 (80%) of 7,761 alerts were overridden in 1,150 patients. In this sample, only 10% of alerts were triggered by an exact match between the drug ordered and allergy listed. Physicians' most common reasons for overriding alerts were "Aware/Will monitor" (55%), "Patient does not have this allergy/tolerates" (33%), and "Patient taking already" (10%). In a stratified random subset of 320 patients (28% of 1,150) on chart review, 19 (6%) experienced ADEs attributed to the overridden drug; of these, 9 (47%) were serious. None of the ADEs was considered preventable, because the overrides were deemed clinically justifiable. The degree of completeness of patients' allergy lists was highly variable and generally low in both paper charts and the CPOE system.Conclusion: Overrides of drug-allergy alerts were common and about 1 in 20 resulted in ADEs, but all of the overrides resulting in ADEs appeared clinically justifiable. The high rate of alert overrides was attributable to frequent nonexact match alerts and infrequent updating of allergy lists. Based on these findings, we have made specific recommendations for increasing the specificity of alerting and thereby improving the clinical utility of the drug allergy alerting system.