Drug-Drug Interaction Override reasons

[Dean Sittig]

During the multi-site data collection for our recently published manuscript on drug-drug interactions for high-priority drug pairs, we noticed that every organization had a different set of allowable reasons that their users could choose from to document their reason for overriding a particular alert. This was coupled with simultaneous requests from 2 of our colleagues at different organizations asking us for the “best set” of alert override reasons. Therefore, we started a new multi-site study to identify a set of recommended alert override reasons.

[Victoria Bradley]

Do you need override reasons from additional sites?

[Brigette Quinn]

Thanks for starting this discussion Dr. Sittig,
In my last role as an experienced critical care RN, I would rapidly click through clinical alerts for drug reactions. As an example, if a patient was “allergic” to one opiate (Codeine) then drug warnings would pop up each time (in Cerner in a large academic medical center) I attempted to administer, or document the medication.
Alert fatigue, much like alarm fatigue offers a “cry wolf” idiom in that attention is no longer directed at what may sometimes be an important alert.

What is important in the build, from my perspective, is that not only are drug-drug alert interactions consistent and supported in clinical evidence, but that they are useful to the clinician.

I wonder if the alerts could also be tailored to an experience/qualification level. For example, some alerts would quickly be overridden by anesthesia, but a novice RN or MD might benefit. My RN students do benefit from learning alerts/interactions as their pharmacology knowledge is weak for about the first 5 years of nursing.

I look forward to more on this discussion!
Brigette

[Dean Sittig]

Brigette: I know that several orgs have tried at least eliminating some docs from some alerts. like the anesthesiologists you mention. Often, the doses that an anesthesiologist gives during surgery are huge overdoses for an outpatient clinic, so they often stop these alerts to anesthesiology in surgery. similar for oncology. I’m not so sure about the “level of experience” idea, although I do think all junior members of the team should get the alerts. in general, the theory at least is that the alerts are for cases in which the clinician “forgot” not that they didn’t know about the issue so not sure whether you should turn off for the more experienced folks. I do think we should improve the specificity of the alerts, though. that would help everyone.

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