Study underscores need to improve clinical alerts
- Nearly three-fourths of medication-related clinical decision support alerts in inpatients were overridden, according to a new study in the Journal of the American Medical Informatics Association (JAMIA), which concluded 40% of overrides were inappropriate.
- Researchers studied alerts over a three-year period at a nearly 800-bed teaching institution.
- Overrides of renal and age-based drug substitutions were mostly inappropriate. By contrast, most duplicate drug, patient allergy and formulary substitution alerts were appropriate — suggesting the potential for refinement to reduce alert fatigue, researchers said.
Alert fatigue is a major issue for doctors and staff working in a hospital setting, and one that contributes to the problem of medical errors. In a national survey, 19 out of 20 hospitals named alarm fatigue as their top patient safety concern.
A recent study by The Doctors Company, found that user error, such as data entry mistakes and alert fatigue, figured in 58% of EHR-related malpractice claims. But the research also highlighted system factors such as failure of alerts and alarms.
The problem has implications for clinician turnover as well. Research has shown that rather than enhance provider satisfaction, EHR alerts can overwhelm clinicians and drive them to consider quitting their jobs.
In 2013, the Joint Commission issued a national patient safety goal requiring accredited hospitals and critical access hospitals to improve their clinical alarm systems. The two-part goal tasked facilities to increase awareness of potential risks associated with alerts and implement steps to address those risks.
The risk that multiple alarms will result in alert fatigue and cause clinicians to miss those alerts that signal a real crisis or provide important information has prompted efforts to develop better algorithms. The JAMIA study suggests that fine-tuning medication alerts is one place to start.