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EHR Alerts on Opioids: Too Much of a Good Thing?

DENVER – Perhaps based on the theory that, if a little is good, a lot must be better, emergency medicine professionals are being overwhelmed with electronic health record alerts on opioids.

That’s according to a study, published online recently by Annals of Emergency Medicine, which offered this example: To prevent a single adverse drug event, one commercial electronic health record opioid warning system broadcast 123 unnecessary and clinically inconsequential alerts.

"The danger here is that medical providers may develop 'alert fatigue,' leading to compromised patient safety,” said lead study author Emma Genco, MS, of the University of Colorado School of Medicine in Denver. “It is well established that clinical decision support prevents adverse drug events, but it is essential that alerting systems be refined to highlight only the clinically significant alerts."

The retrospective chart review study focused on type, override rates, events and event preventability with opioid drug alerts to assess adverse drug event occurrences for ED visits in a large urban academic medical center using a commercial EHR system with clinical decision support. Participants were adults who arrived to the ED every fifth day between September 2012 and January 2013.

The study points out that, while 14 of 4,581 patients experienced an adverse drug event (ADE), with eight due to opioids, none turned out to be preventable by the clinical decision support alert of the commercial EHR.

In fact, 98.9% percent of opioid alerts did not result in an actual or averted ADE and 96.3% of opioid alerts were overridden, according to the results.

Opioid drug alerts were more likely to be overridden than non-opioid alerts. In addition, opioid drug allergy alerts were twice as likely to be overridden, while opioid duplicate therapy alerts were 1.57 times as likely to be overridden.

Most likely to override the alerts were pharmacists and physicians assistants; medical residents were the least likely to override.

“Overridden opioid alerts did not result in adverse drug events,” study authors conclude. “Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts.”

"We need to improve the 'signal to noise' ratio of these alerts, especially in the chaotic environment of the emergency department," Genco said. "Interruptions are already a significant fact of life in emergency departments, which is why we need to eliminate the meaningless ones."

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