Drug interactions are a serious hazard in hospitals and in the community. If patients receive prescriptions for incompatible medications, they can experience severe side effects that may even be life threatening. Electronic medical records are intended to warn prescribers and pharmacists about potentially dangerous interactions, but many do so indiscriminately. The result is something called alert fatigue.
Why Is Alert Fatigue Dangerous?
Think of it a bit like the boy who cried wolf. After the villagers came running to help him twice when there was no wolf, they didn’t pay attention to his next alert. So the wolf ate his sheep. When clinicians receive too many warnings, they may not pay attention to really important drug interactions that can cause patients serious harm.
Changing the Alert System to Reduce Alert Fatigue:
A team at St. Jude Children’s Research Hospital reviewed their alert system (Daniels et al, Pediatrics, Feb. 2019). They removed unnecessary alerts and provided additional information on the most important drug interactions. After they finished, they tracked clinicians’ reactions. Alert overrides dropped by 40 percent. One important change linked alerts to the patient’s laboratory data, making them much more targeted and less likely to result in alert fatigue.
The overhaul to the system made a significant impact. There were 40 percent fewer drug-drug interaction alerts cropping up for clinicians. Attending physicians actually had up to 82 percent fewer warnings about drug interactions. The changes in the system did result in two “patient safety events” during the study period. We don’t know whether those events resulted in patient harm, nor how many such events occurred during a similar time frame before the changes were undertaken.
The authors conclude:
“Our quality improvement effort refined 47% of all DDI alerts that were firing during historical analysis, significantly reduced the number of DDI alerts in a 54-week period, and established a model for sustained alert refinements.”
We discussed alert fatigue, drug interactions and overmedication with Dr. Jennifer Jacobs in Show 1134: Do You Really Need That Pill?