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Study: Many EHR Alerts for Opioids Prove Clinically Inconsequential

November 12, 2015
by Rajiv Leventhal
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One hospital’s commercial electronic health record (EHR) warning system for opioids fired off 123 unnecessary and clinically inconsequential alerts, according to the results of a new study published online in Annals of Emergency Medicine.

In the study, 14 of 4,581 patients experienced an adverse drug event (ADE), with eight due to opioids, and none were preventable by the clinical decision support piece of the commercial electronic health record.

Overall, 98.9 percent of opioid alerts did not result in an actual or averted ADE and 96.3 percent of opioid alerts were overridden. Opioid drug alerts were more likely to be overridden than non-opioid alerts and opioid drug allergy alerts were twice as likely to be overridden. Pharmacists and physicians assistants most frequently overrode opioid drug alerts and residents overrode them the least, according to the research.

"Our electronic health record warning system on opioids is overwhelming providers with unnecessary and clinically inconsequential alerts," said lead study author Emma Genco, of the University of Colorado School of Medicine in Denver. "The danger here is that medical providers may develop 'alert fatigue,' leading to compromised patient safety. 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."

Genco added, “We need to improve the 'signal to noise' ratio of these alerts, especially in the chaotic environment of the emergency department. 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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