Category: Federal Forum Posters
Purpose: The aim of this study was to analyze characteristics of adverse drug reactions(ADRs) related clinical decision support(CDS) alert overrides, assess the effectiveness of ADRs alert system for prevention of ADRs, and suggest methods for decreasing preventable ADRs.
Methods: In Asan Medical Center, medications with ADRs reported by health-system providers are classified “caution” and “prohibition” after conducting causality assessment of ADRsa by pharmacists and physicians. When medications with ADRs are ordered, ADRs alert informed the clinicians. They can either discontinue the order or continue with the medication order by overriding the alert, which requires entering a free-text reason.
We evaluated ADRs alerts for inpatients within in our health system during a 1 year period(2017). Factors that were measured were drug and drug class that triggered alerts, frequency of override reasons, and characteristics of ADRs. We analyzed the first overridden alert within each patient and classified in two categories according to the ADRs assessment.
Results: A total of 4,101(90%) of 4,551 alerts were overridden in 259 patients with 342 medications that were classified as “caution”(295 medications) and “prohibition”(47 medications) by assessment of ADR. The average number of ADRs alerts is 15.8 per patient and 12.0 per medications. In the “caution” group, clinicians’ most common reasons for overriding alerts were “no reasonable alternatives”(39.7%), “aware/premedication/will monitor”(21.7%). While, in the “prohibition” group, they were “no reasonable alternatives”(28.6%), “patient does not have this allergy/tolerates”(24.5%), “desensitization protocol/skin test”(22.4%). Drug classes that triggered overridden alerts were antimicrobial agents(42.0%), anticancer drugs(22.3%), nonsteroidal anti-inflammatory drugs (NSAIDs)(7.4%) in the “caution” group. In the “prohibition” group, overridden drug classes were similar. Only 1 patient of 259 patients experienced ADRs attributed to the overridden drug and it was not serious.
Conclusion: Overrides of ADRs alerts were common but low rate of re-experienced ADRs. ADRs alert were repeated same patients and medications because of not reassessing when patients tolerates ADRs. The high rate of alert overridden was attributable to no reasonable alternatives and frequent nonexact match alerts. Based on these findings, we have made recommendations for increasing the specificity of alerting and thereby improving the clinical utility of the ADRs alerting system.
Minkyoung Kang– Aasn Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea