Drug safety alert generation and overriding in a large Dutch university medical centre.
Pharmacoepidemiol Drug Saf
; 18(10): 941-7, 2009 Oct.
Article
em En
| MEDLINE
| ID: mdl-19579216
ABSTRACT
PURPOSE:
To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre.METHODS:
A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months.RESULTS:
In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug-drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium-level seriousness were overridden more often (55%) than low-level (22%) or high-level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides.CONCLUSIONS:
Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Serviço de Farmácia Hospitalar
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Quimioterapia Assistida por Computador
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Sistemas de Alerta
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Sistemas de Apoio a Decisões Clínicas
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Centros Médicos Acadêmicos
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Sistemas de Registro de Ordens Médicas
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Erros de Medicação
Tipo de estudo:
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article