Unintended effects of a computerized alert to prevent drug interactions

January 01, 0001

Unintended effects of a computerized alert to prevent drug interactions

The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts. These US authors evaluated the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole in a randomized clinical trial. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice.

They found: "The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2% (111 of 194 hard stop alerts) in the intervention group and 13.5% (20 of 148) in the control group (adjusted odds ratio, 0.12). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients."

The authors concluded: "An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits."

Ah, the law of unintended consequences. Back to the drawing board.


For the full abstract, click here.

Arch Intern Med 170(17):1578-1583, 27 September 2010 © 2010 to the American Medical Association
Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction-A Randomized Controlled Trial. Brian L. Strom, Rita Schinnar, Faten Aberra, et al. Correspondence to Dr. Strom: [email protected]

Category: HSR. Health Services Research. Keywords: computerized order entry, prescribing, drug interaction, warfarin, trimethoprim-sulfamethoxazole, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 26 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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