The electronic health record can be a wonderful tool. As a single application for orders, results review, and integrated documentation storehouse, it holds massive potential.
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”
http://www.ncbi.nlm.nih.gov/pubmed/26553282