Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Comput Methods Programs Biomed. 2013 Jul;111(1):17-25. doi: 10.1016/j.cmpb.2013.02.006. Epub 2013 Apr 19.
Adverse drug reactions (ADR) increase morbidity and mortality; potential drug-drug interactions (DDI) increase the probability of ADR. Studies have proven that computerized drug-interaction alert systems (DIAS) might reduce medication errors and potential adverse events. However, the relatively high override rates obscure the benefits of alert systems, which result in barriers for availability. It is important to understand the frequency at which physicians override DIAS and the reasons for overriding reminders.
All the DDI records of outpatient prescriptions from a tertiary university hospital from 2005 and 2006 detections by the DIAS are included in the study. The DIAS is a JAVA language software that was integrated into the computerized physician order entry system. The alert window is displayed when DDIs occur during order entries, and physicians choose the appropriate action according to the DDI alerts. There are seven response choices are obligated in representing overriding and acceptance: (1) necessary order and override; (2) expected DDI and override; (3) expected DDI with modified dosage and override; (4) no DDI and override; (5) too busy to respond and override; (6) unaware of the DDI and accept; and (7) unexpected DDI and accept. The responses were collected for analysis.
A total of 11,084 DDI alerts of 1,243,464 outpatient prescriptions were present, 0.89% of all computerized prescriptions. The overall rate for accepting was 8.5%, but most of the alerts were overridden (91.5%). Physicians of family medicine and gynecology-obstetrics were more willing to accept the alerts with acceptance rates of 20.8% and 20.0% respectively (p<0.001). Information regarding the recognition of DDIs indicated that 82.0% of the DDIs were aware by physicians, 15.9% of DDIs were unaware by physicians, and 2.1% of alerts were ignored. The percentage of total alerts declined from 1.12% to 0.79% during 24 months' study period, and total overridden alerts also declined (from 1.04% to 0.73%).
We explored the physicians' behavior by analyzing responses to the DDI alerts. Although the override rate is still high, the reasons why physicians may override DDI alerts were well analyzed and most DDI were recognized by physicians. Nonetheless, the trend of total overrides is in decline, which indicates a learning curve effect from exposure to DIAS. By analyzing the computerized responses provided by physicians, efforts should be made to improve the efficiency of the DIAS, and pharmacists, as well as patient safety staffs, can catch physicians' appropriate reasons for overriding DDI alerts, improving patient safety.
药物不良反应（ADR）会增加发病率和死亡率；潜在的药物-药物相互作用（DDI）会增加 ADR 的概率。研究表明，计算机化药物相互作用警报系统（DIAS）可能会减少用药错误和潜在的不良事件。然而，相对较高的覆盖率掩盖了警报系统的益处，从而导致可用性方面的障碍。了解医生覆盖 DIAS 的频率以及覆盖提醒的原因非常重要。
本研究纳入了 2005 年和 2006 年某三级大学医院门诊处方的所有 DDI 记录，这些记录是由 DIAS 检测出来的。DIAS 是一种集成到计算机化医嘱输入系统中的 JAVA 语言软件。当医嘱输入中发生 DDI 时，会显示警报窗口，医生根据 DDI 警报选择适当的操作。有七种反应选择被强制用于表示覆盖和接受：（1）必要的医嘱和覆盖；（2）预期的 DDI 和覆盖；（3）预期的 DDI 加剂量覆盖；（4）无 DDI 和覆盖；（5）太忙无法响应和覆盖；（6）不知道 DDI 并接受；（7）意外的 DDI 并接受。对这些反应进行了收集和分析。
共有 11084 个 DDI 警报出现在 1243464 张门诊处方中，占所有计算机化处方的 0.89%。接受率为 8.5%，但大多数警报都被覆盖（91.5%）。家庭医学和妇产科医生更愿意接受警报，接受率分别为 20.8%和 20.0%（p<0.001）。关于对 DDI 的认识，有 82.0%的 DDI 被医生识别，15.9%的 DDI 未被医生识别，2.1%的警报被忽略。在 24 个月的研究期间，总警报百分比从 1.12%下降到 0.79%，总覆盖警报也下降（从 1.04%下降到 0.73%）。
我们通过分析对 DDI 警报的反应来探讨医生的行为。尽管覆盖率仍然很高，但我们对医生可能覆盖 DDI 警报的原因进行了很好的分析，并且大多数 DDI 都被医生识别。尽管如此，总覆盖的趋势正在下降，这表明从接触 DIAS 开始出现了学习曲线效应。通过分析医生提供的计算机化反应，应努力提高 DIAS 的效率，药剂师和患者安全人员可以发现医生覆盖 DDI 警报的适当原因，从而提高患者安全性。
