Alert fatigue often related to uncertainty of purpose

A study by Regenstrief Institute in Indianapolis and U.S. Department of Veterans Affairs investigators provides the first in-depth look at how healthcare providers react to medication alerts generated by electronic medical record systems.1 They found that clinicians often ignore alarms because they are uncertain what they mean.

The authors identified nine factors that influence prescribers as they encounter alerts, and they provided a detailed description of 44 components that contribute to these factors. The researchers found that prescribers sometimes were unsure why an alert was appearing, and they also determined that alert designs were more pharmacist-oriented than physician- or nurse practitioner-oriented, in spite of the fact that doctors and nurse practitioners were the principal prescribers.

The researchers plan to use this information to improve the design of medication alerts and diminish the phenomenon known as alert fatigue, where providers can become desensitized and might start unintentionally ignoring some important warnings, says Regenstrief Institute investigator Alissa Russ, PhD, a research scientist with the Center of Excellence on Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center in Indianapolis. She is first author of the study and is an adjunct assistant professor of pharmacy practice at Purdue University in West Lafayette, IN.

The researchers observed providers as they treated patients to learn about the strengths and weaknesses of medication alerts, Russ says. Medication alerts provide the healthcare team with computer-generated information on a variety of drug-related issues. Among the most common medication alerts are warnings about patient allergies, drug interactions, and duplicate prescriptions. The alerts, critical to patient safety, can be triggered by many factors including the prescription of a new medication or a change in a patient's laboratory test results.

However, healthcare providers might experience alert fatigue and unintentionally overlook important alerts if the electronic medical record system generates too many medication alerts, Russ explains. Common example are alerts that don't apply to the patient , such a warning about a drug the patient already has been taking without problems or an alert that provides too much extra information. The goal is to develop alerts that aid healthcare providers more effectively and enhance patient safety, Russ says.

"As a human factors research scientist, I am interested in learning how to improve the usability of electronic medical records systems so doctors, nurses, and pharmacists can work more effectively," Russ says. "Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems."

During the study, 320 medication alerts were generated by an electronic medical record system as 30 doctors, nurse practitioners, and pharmacists treated 146 patients in outpatient clinics. The study authors observed and analyzed factors that influenced how healthcare providers perceive, interpret, and respond to alerts.

"Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as EMR systems expand beyond single hospitals and share more data," Russ says.


1. Russ AL, Zillich AJ, McManus MS, et al. Prescribers' interactions with medication alerts at the point of prescribing: A multi-method, in situ investigation of the human-computer interaction. Int J Med Inform 2012; 81(4):232-43.


• Alissa Russ, PhD, Research Scientist, Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis. Telephone: (317) 274-7722. E-mail: