Zenziper Straichman Yael, Kurnik Daniel, Matok Ilan, Halkin Hillel, Markovits Noa, Ziv Amitai, Shamiss Ari, Loebstein Ronen
Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel; Department of Clinical Pharmacy, Hebrew University, Jerusalem, Israel.
Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel; Section of Clinical Pharmacology and Toxicology, Rambam Health Care Center, and Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Int J Med Inform. 2017 Nov;107:70-75. doi: 10.1016/j.ijmedinf.2017.08.008. Epub 2017 Aug 31.
Clinical decision support systems (CDSS) reduce prescription errors, but their effectiveness is reduced by high alert rates, "alert fatigue", and indiscriminate rejection.
To compare acceptance rates of alerts generated by the SafeRx prescription CDSS among different alert types and departments in a tertiary care hospital, identify factors associated with alert acceptance, and determine whether alert overrides were justified.
In a retrospective study, we compared acceptance rates of all prescription alerts generated in 2013 in 18 departments of Israel's largest tertiary care center. In a prospective study in 2 internal medicine departments, we collected data on factors potentially associated with alert override, and an expert panel evaluated the justification for each overridden alert. We used multivariate analyses to examine the association between patient and physician-related factors and alert acceptance.
In the retrospective study, of 390,841 prescriptions, 37.1% triggered at least one alert, 5.3% of which were accepted. Acceptance rates ranged from 7.9% for excessive dose alerts to 4.0% for duplicate drug and major drug-drug interactions alerts (p<0.001). In the prospective study, common reasons for alert overriding included "irrelevance to the specific condition" and "medication previously tolerated by the patient". Weekend shifts (incident rate ratio [IRR]=1.50 [95% CI, 1.01-2.22]) and a specific department (IRR=1.87 [1.23-2.87]) were associated with higher alert acceptance, while night shift (IRR=0.47 [0.26-0.85]) was associated with alert override. Most alert overrides (88.6%) were judged justified.
The vast majority of SafeRx alerts are overridden, and overriding is justified in most cases. Minimizing the number of alerts is essential to reduce the likelihood of developing "alert fatigue". Our findings may inform a rational, department-specific approach for alert silencing.
临床决策支持系统（CDSS）可减少处方错误，但其有效性会因高警报率、“警报疲劳”和不加区分的拒绝而降低。
比较三级护理医院中不同警报类型和科室的SafeRx处方CDSS生成警报的接受率，确定与警报接受相关的因素，并判断警报被驳回是否合理。
在一项回顾性研究中，我们比较了以色列最大的三级护理中心18个科室2013年生成的所有处方警报的接受率。在两项内科前瞻性研究中，我们收集了可能与警报驳回相关的因素的数据，一个专家小组评估了每个被驳回警报的合理性。我们使用多变量分析来研究患者和医生相关因素与警报接受之间的关联。
在回顾性研究中，390,841份处方中，37.1%触发了至少一次警报，其中5.3%被接受。接受率从过量用药警报的7.9%到重复用药和主要药物相互作用警报的4.0%不等（p<0.001）。在前瞻性研究中，警报被驳回的常见原因包括“与特定病情无关”和“患者先前耐受的药物”。周末班次（发生率比[IRR]=1.50[95%CI，1.01 - 2.22]）和特定科室（IRR=1.87[1.23 - 2.87]）与较高的警报接受率相关，而夜班（IRR=0.47[0.26 - 0.85]）与警报被驳回相关。大多数警报被驳回（88.6%）被判定为合理。
绝大多数SafeRx警报被驳回，且在大多数情况下驳回是合理的。尽量减少警报数量对于降低产生“警报疲劳”的可能性至关重要。我们的研究结果可能为一种合理的、针对科室的警报静音方法提供依据。
