E-prescribing systems cause "alert fatigue," study says

A recent study of doctors’ e-prescribing habits says that the software’s accompanying medication safety alerts are so often ignored that the alerts are “more of a nuisance than an asset.”

Clinicians overrode more than 90 percent of drug interaction alerts and 77 percent of drug allergy alerts, according to the study, called “Overrides of Medication Alerts in Ambulatory Care.” The study was published in the Feb. 9 issue of the Archives of Internal Medicine, and was led by investigators at the Dana-Farber Cancer Institute and the Beth Israel Deaconess Medical  Center in Boston.

Given that clinicians so frequently override the alerts, which are designed to warn of potential medication errors, the authors conclude that the usefulness of medication alerts is “grossly inadequate.” Thus, the alerts “may be inadequate” to ensure patient safety, the study says.

“The sheer volume of alerts generated by electronic prescribing systems stands to limit the safety benefits,” says Thomas Isaac, MD, MBA, one of the study’s authors. “Too many alerts are generated for unlikely events, which could lead to alert fatigue.”

To conduct the study, researchers reviewed the electronic prescriptions and associated medication safety alerts from 2,872 clinicians at outpatient practices in Massachusetts, New Jersey, and Pennsylvania from January through September 2006.

Of the 3.5 million electronic prescriptions covered in the study, nearly 7 percent produced an alert for a drug interaction or a drug allergy. Nearly 99 percent of the alerts were for a potential interaction with a drug a patient already takes, the study says.

The study’s authors offer a few recommendations to improve medication safety alerts, including reclassifying the severity of alerts; providing an option for clinicians to suppress alerts for medications a patient already has received; and customizing the alerts for a clinician's specialty.