Drug Alerts in EHRs Contribute to Alarm Fatigue, Study Finds

TOPIC ALERT:

Electronic health record-based medication alerts might occur too frequently and contain warnings that are too detailed to help busy health care providers, according to a study published in the International Journal of Medical Informatics, FierceHealthIT reports (Terry, FierceHealthIT, 3/29).

When medical devices issue too many audio and visual alerts, health care providers can experience alarm fatigue, which often leads them to ignore or become desensitized to such alerts (iHealthBeat, 3/26).

Study Details

For the study, researchers from the Regenstrief Institute and the Department of Veterans Affairs followed 30 physicians, nurse practitioners and pharmacists treating 146 patients in several outpatient clinics (FierceHealthIT, 3/29).

Researchers observed how the health care providers interpreted and responded to 320 medication alerts issued during the study period.

Key Findings

According to the study, many health care providers said that they sometimes were not sure why certain alerts appeared.

Researchers also found that the alerts seemed to target pharmacists more than physicians or nurse practitioners (Oh, Becker's Hospital Review, 3/29).

Implications

Alissa Russ -- co-author of the report and a research scientist at the Center of Excellence on Implementing Evidence-Based Practice at Indianapolis' Richard L. Roudebush VA Medical Center -- said, "Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems."

She added, "Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as [EHR] systems expand beyond single hospitals and share more data" (FierceHealthIT, 3/29).

Peter Basch
Clearly alert fatigue is real, and there needs to be an attempt to find that "sweet spot" between over- and under-alerting such that patient harm is minimized. EHRs typically license medication and medication interaction databases from external content vendors. This same content exists (along with the same warnings / alerts) whether or not they are embedded in the EHR, available via manual inputting to a separate online app, or contained in print in a large reference book. The duty to the patient re medication safety is the same - whether or not the information / alerts are viewed and acted upon, viewed and ignored, or never viewed. EHRs allow for viewing of such content / warnings without double entry or without consulting a reference text. EHRs can (and currently often do not)further enhance that experience by allowing for filtered views. The fix to this problem starts with "fixing" medication interaction reference materials - and then "fixing" EHR filtered views.

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