• Research and Education

    Electronic medication safety alerts in ambulatory care: friend or foe?

    For ambulatory care clinicians who use electronic prescribing, medication safety alerts are familiar, but not always welcome.

    Most alerts warn about the potential adverse effects of combining medications. Clinicians are often ambivalent about these warnings. Some alerts are useful, while others are a nuisance. Busy prescribers who encounter numerous alerts daily can become habituated, a phenomenon known as “alert fatigue,” and are at higher risk of ignoring important warnings.

    In order to assist clinicians who prescribe electronically, the Dana-Farber Center for Patient Safety, with support from the Physicians’ Foundation for Health Systems Excellence, studied the value of drug interaction alerts.

    We examined the behavior of more than 2,000 clinicians in three states who used the PocketScript electronic prescribing system. We calculated the rate with which clinicians accepted (and rejected) high-severity drug interaction alerts among all classes of medications.

    This information offers important insight into which types of alerts clinicians found most and least useful. Acceptance rates varied between 2.2% and 43.1%, depending on the interacting classes of medications.

    We list here the high-severity medication interactions that had the highest and lowest acceptance rates. The list may also help clinicians who lack access to electronic prescribing, since the list of accepted alerts identifies common medication combinations that should often be avoided.

    See a complete list of the 100 highest and lowest acceptance rates  

    High severity interactions with highest accept rates  

    Rate 

    1

    non-cardioselective beta blockers*macrolides

    43.1

    2

    macrolides*antiarrhythmic agents

    39.7

    3

    quinolones*antiarrhythmic agents

    38.5

    4

    beta-lactamase inhibitors*antimetabolites

    31.7

    5

    macrolides*calcium channel blocking agents

    25.0

    6

    ophthalmic glaucoma agents*adrenergic bronchodilators

    24.7

    7

    macrolides*coumarins and indandiones

    24.2

    8

    vitamins*vitamins

    24.1

    9

    potassium-sparing diuretics*minerals and electrolytes

    23.7

    10

    sulfonamides*coumarins and indandiones

    23.4

    11

    sulfonamides*antimetabolites

    23.4

    12

    anticholinergics/antispasmodics*TOPIRAMATE

    22.4

    13

    tetracyclines*antimetabolites

    22.2

    14

    laxatives*antihypertensive combinations

    22.0

    15

    impotence agents*antianginal agents

    21.8

    16

    potassium-sparing diuretics*angiotensin converting enzyme inhibitors

    21.7

    17

    urinary antispasmodics*TOPIRAMATE

    21.6

    18

    antihypertensive combinations*antihypertensive combinations

    21.5

    19

    anorexiants*SSNRI antidepressants

    21.0

    20

    analgesic combinations*SSNRI antidepressants

    20.8

    21

    smoking cessation agents*quinolones

    20.2

    22

    calcium channel blocking agents*antiarrhythmic agents

    20.1

    23

    upper respiratory combinations*quinolones

    20.0

    24

    smoking cessation agents*anorexiants

    19.8

    25

    upper respiratory combinations*TOPIRAMATE

    19.7


    Printable list of top 20 potentially dangerous drug combinations  

    For more information, contact Thomas_Isaac@dfci.harvard.edu 

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