Unfortunately, much of the currently realized potential is that of unintended harms and inefficiencies.
Even the most seemingly innocuous of checks – those meant to ensure safe medication ordering – have gone rogue, and no one seems capable of restraining them. These authors report on the real-world effectiveness of adverse drug alerts related to opiates. These were not public health-related educational interventions, but, simply, duplicate therapy, drug allergy, drug interaction, and pregnancy/lactation safety alerts. These commonly used medications frequently generate medication safety alerts, and are reasonable targets for study in the Emergency Department.
In just a 4-month study period, these authors retrospectively identified 826 patients for whom an opiate-related medication safety alert was triggered, and these 4,742 alerts constituted the cohort for analysis. Of these insightful, timely, and important contextual interruptions, these orders were overridden 96.3% of the time. And, if only physicians had listened, these overridden alerts would have prevented: zero adverse drug events.
In fact, all 8 opiate-related adverse drug events could not have been prevented by alerts – most of which were itching, anyway. The authors do attribute 38 potentially prevented adverse drug events to the 3.7% of accepted alerts – although, again, these would probably mostly just have been itching.
Thousands of alerts. A handful of serious events not preventable. A few episodes of itching averted. This is the “quality” universe we live in – one in which these alerts paradoxically make our patients less safe due to sheer volume and the phenomenon of “alert fatigue”.
“Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department”