Hospital Staff Often Override Systems' Drug Allergy Warnings


WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often computerized allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and his colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database in order to reduce the ambiguity of handwritten prescriptions. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings about potential drug allergies in 56% of the orders, and changed the medication in 44% of the orders.

When the data were broken down by provider type, physicians were the least likely to override warnings, although more than half of them did so. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%).

The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included “not a true allergy,” “medical reason outweighed risk,” and “physician/pharmacist approved.”

CPOEs are not yet widely used, but they have the potential to improve patient safety, the researchers noted.

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