Wasserman Rachel L, Goss Foster R, Seger Diane L, Blumenthal Kimberly G, Lo Ying-Chih, Edrees Heba H, Varghese Sheril, Wang Liqin, Blackley Suzanne, Bates David W, Zhou Li
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
Massachusetts College of Pharmacy and Health Sciences, MCPHS University, Boston, Massachusetts, USA.
BMJ Health Care Inform. 2025 May 25;32(1):e101259. doi: 10.1136/bmjhci-2024-101259.
Despite opioids comprising a majority of drug allergy alert (DAA) overrides, few studies have designed recommendations for clinical decision support (CDS) systems. We determined the frequency of opioid analogue DAA overrides and assessed DAAs overridden by patient and provider type, the most common allergic reactions documented in electronic health records (EHR), reaction severity, and associated hypersensitivity.
We conducted an observational cross-sectional study of DAAs in two geographically remote health systems. Patients were included if they were 18 years or older and had an opioid DAA generated when a medication was ordered. Patient and provider demographics, drug allergies, medication ordered, alert overrides, drug allergy reactions and DAA history were collected. Opioid analogue allergies were analysed by reaction type documented in the EHR, reaction severities (high, medium or low) and hypersensitivity reaction. Based on these factors, alerts were recommended to be interruptive requiring a coded response or changed to be non-interruptive (informational).
There were 700 493 alerts concerning opioid analogues fired for 50 527 patients across both sites, and 71.8% of these alerts were overridden. Nearly three-quarters of overridden reactions had a low to medium severity level at both institutions. Only 29.3% of the overridden alerts were truly immune-mediated.
Our recommendations would reduce interruptive alerts in half by converting them to non-interruptive alerts (46.4%). The data suggest opportunities to improve opioid-related CDS systems.
We evaluated overrides of opioids and used this data to suggest ways to redesign DAAs to decrease alert override rates, combat alert fatigue and improve patient safety.
尽管阿片类药物在药物过敏警报（DAA）忽略中占大多数，但很少有研究针对临床决策支持（CDS）系统制定建议。我们确定了阿片类药物类似物DAA忽略的频率，并评估了按患者和提供者类型划分的被忽略的DAA、电子健康记录（EHR）中记录的最常见过敏反应、反应严重程度以及相关的超敏反应。
我们对两个地理位置偏远的医疗系统中的DAA进行了一项观察性横断面研究。纳入的患者年龄在18岁及以上，且在开具药物时生成了阿片类药物DAA。收集患者和提供者的人口统计学信息、药物过敏情况、开具的药物、警报忽略情况、药物过敏反应和DAA历史记录。根据EHR中记录的反应类型、反应严重程度（高、中或低）和超敏反应对阿片类药物类似物过敏进行分析。基于这些因素，建议将警报设置为需要编码响应的中断性警报，或更改为非中断性警报（信息性警报）。
两个地点针对50527名患者发出了700493条有关阿片类药物类似物的警报，其中71.8%的警报被忽略。在两个机构中，近四分之三被忽略的反应严重程度为低至中度。被忽略的警报中只有29.3%是真正由免疫介导的。
我们的建议将通过将中断性警报转换为非中断性警报（46.4%），使中断性警报减少一半。数据表明有机会改进与阿片类药物相关的CDS系统。
我们评估了阿片类药物的忽略情况，并利用这些数据提出重新设计DAA的方法，以降低警报忽略率、应对警报疲劳并提高患者安全性。
