The Effect of Eliminating Intermediate Severity Drug-Drug Interaction Alerts on Overall Medication Alert Burden and Acceptance Rate

Amy M. Knight, Joyce Maygers, Kimberly A. Foltz, Isha S. John, Hsin Chieh Yeh, Daniel J. Brotman

Research output: Contribution to journalArticle

Abstract

Objective  This study aimed to determine the effects of reducing the number of drug-drug interaction (DDI) alerts in an order entry system. Methods  Retrospective pre-post analysis at an urban medical center of the rates of medication alerts and alert acceptance during a 5-month period before and 5-month period after the threshold for firing DDI alerts was changed from intermediate to severe. To ensure that we could determine varying response to each alert type, we took an in-depth look at orders generating single alerts. Results  Before the intervention, 241,915 medication orders were placed, of which 25.6% generated one or more medication alerts; 5.3% of the alerts were accepted. During the postintervention period, 245,757 medication orders were placed of which 16.0% generated one or more medication alerts, a 37.5% relative decrease in alert rate (95% confidence interval [CI]: -38.4 to -36.8%), but only a 9.6% absolute decrease (95% CI: -9.4 to -9.9%). 7.4% of orders generating alerts were accepted postintervention, a 39.6% relative increase in acceptance rate (95% CI: 33.2-47.2%), but only a 2.1% absolute increase (95% CI: 1.8-2.4%). When only orders generating a single medication alert were considered, there was a 69.1% relative decrease in the number of orders generating DDI alerts, and an 85.7% relative increase in the acceptance rate (95% CI: 58.6-126.2%), though only a 1.8% absolute increase (95% CI: 1.3-2.3%). Conclusion  Eliminating intermediate severity DDI alerts resulted in a statistically significant decrease in alert burden and increase in the rate of medication alert acceptance, but alert acceptance remained low overall.

Original languageEnglish (US)
Pages (from-to)927-934
Number of pages8
JournalApplied clinical informatics
Volume10
Issue number5
DOIs
StatePublished - Jan 1 2019

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Drug interactions
Drug Interactions
Confidence Intervals
Pharmaceutical Preparations

Keywords

  • alert fatigue
  • clinical decision support
  • computerized physician order entry
  • high-alert medications
  • medication alerts

ASJC Scopus subject areas

  • Health Informatics
  • Computer Science Applications
  • Health Information Management

Cite this

The Effect of Eliminating Intermediate Severity Drug-Drug Interaction Alerts on Overall Medication Alert Burden and Acceptance Rate. / Knight, Amy M.; Maygers, Joyce; Foltz, Kimberly A.; John, Isha S.; Yeh, Hsin Chieh; Brotman, Daniel J.

In: Applied clinical informatics, Vol. 10, No. 5, 01.01.2019, p. 927-934.

Research output: Contribution to journalArticle

Knight, Amy M. ; Maygers, Joyce ; Foltz, Kimberly A. ; John, Isha S. ; Yeh, Hsin Chieh ; Brotman, Daniel J. / The Effect of Eliminating Intermediate Severity Drug-Drug Interaction Alerts on Overall Medication Alert Burden and Acceptance Rate. In: Applied clinical informatics. 2019 ; Vol. 10, No. 5. pp. 927-934.
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abstract = "Objective  This study aimed to determine the effects of reducing the number of drug-drug interaction (DDI) alerts in an order entry system. Methods  Retrospective pre-post analysis at an urban medical center of the rates of medication alerts and alert acceptance during a 5-month period before and 5-month period after the threshold for firing DDI alerts was changed from intermediate to severe. To ensure that we could determine varying response to each alert type, we took an in-depth look at orders generating single alerts. Results  Before the intervention, 241,915 medication orders were placed, of which 25.6{\%} generated one or more medication alerts; 5.3{\%} of the alerts were accepted. During the postintervention period, 245,757 medication orders were placed of which 16.0{\%} generated one or more medication alerts, a 37.5{\%} relative decrease in alert rate (95{\%} confidence interval [CI]: -38.4 to -36.8{\%}), but only a 9.6{\%} absolute decrease (95{\%} CI: -9.4 to -9.9{\%}). 7.4{\%} of orders generating alerts were accepted postintervention, a 39.6{\%} relative increase in acceptance rate (95{\%} CI: 33.2-47.2{\%}), but only a 2.1{\%} absolute increase (95{\%} CI: 1.8-2.4{\%}). When only orders generating a single medication alert were considered, there was a 69.1{\%} relative decrease in the number of orders generating DDI alerts, and an 85.7{\%} relative increase in the acceptance rate (95{\%} CI: 58.6-126.2{\%}), though only a 1.8{\%} absolute increase (95{\%} CI: 1.3-2.3{\%}). Conclusion  Eliminating intermediate severity DDI alerts resulted in a statistically significant decrease in alert burden and increase in the rate of medication alert acceptance, but alert acceptance remained low overall.",
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AU - John, Isha S.

AU - Yeh, Hsin Chieh

AU - Brotman, Daniel J.

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N2 - Objective  This study aimed to determine the effects of reducing the number of drug-drug interaction (DDI) alerts in an order entry system. Methods  Retrospective pre-post analysis at an urban medical center of the rates of medication alerts and alert acceptance during a 5-month period before and 5-month period after the threshold for firing DDI alerts was changed from intermediate to severe. To ensure that we could determine varying response to each alert type, we took an in-depth look at orders generating single alerts. Results  Before the intervention, 241,915 medication orders were placed, of which 25.6% generated one or more medication alerts; 5.3% of the alerts were accepted. During the postintervention period, 245,757 medication orders were placed of which 16.0% generated one or more medication alerts, a 37.5% relative decrease in alert rate (95% confidence interval [CI]: -38.4 to -36.8%), but only a 9.6% absolute decrease (95% CI: -9.4 to -9.9%). 7.4% of orders generating alerts were accepted postintervention, a 39.6% relative increase in acceptance rate (95% CI: 33.2-47.2%), but only a 2.1% absolute increase (95% CI: 1.8-2.4%). When only orders generating a single medication alert were considered, there was a 69.1% relative decrease in the number of orders generating DDI alerts, and an 85.7% relative increase in the acceptance rate (95% CI: 58.6-126.2%), though only a 1.8% absolute increase (95% CI: 1.3-2.3%). Conclusion  Eliminating intermediate severity DDI alerts resulted in a statistically significant decrease in alert burden and increase in the rate of medication alert acceptance, but alert acceptance remained low overall.

AB - Objective  This study aimed to determine the effects of reducing the number of drug-drug interaction (DDI) alerts in an order entry system. Methods  Retrospective pre-post analysis at an urban medical center of the rates of medication alerts and alert acceptance during a 5-month period before and 5-month period after the threshold for firing DDI alerts was changed from intermediate to severe. To ensure that we could determine varying response to each alert type, we took an in-depth look at orders generating single alerts. Results  Before the intervention, 241,915 medication orders were placed, of which 25.6% generated one or more medication alerts; 5.3% of the alerts were accepted. During the postintervention period, 245,757 medication orders were placed of which 16.0% generated one or more medication alerts, a 37.5% relative decrease in alert rate (95% confidence interval [CI]: -38.4 to -36.8%), but only a 9.6% absolute decrease (95% CI: -9.4 to -9.9%). 7.4% of orders generating alerts were accepted postintervention, a 39.6% relative increase in acceptance rate (95% CI: 33.2-47.2%), but only a 2.1% absolute increase (95% CI: 1.8-2.4%). When only orders generating a single medication alert were considered, there was a 69.1% relative decrease in the number of orders generating DDI alerts, and an 85.7% relative increase in the acceptance rate (95% CI: 58.6-126.2%), though only a 1.8% absolute increase (95% CI: 1.3-2.3%). Conclusion  Eliminating intermediate severity DDI alerts resulted in a statistically significant decrease in alert burden and increase in the rate of medication alert acceptance, but alert acceptance remained low overall.

KW - alert fatigue

KW - clinical decision support

KW - computerized physician order entry

KW - high-alert medications

KW - medication alerts

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