Study: Doctors increasingly override drug allergy alerts in EHR

A consistent rise in physician overrides of drug allergy alerts in electronic health records (EHRs) highlights an urgent need for increased efforts to help reduce alert override rates and alert fatigue among doctors, according to results of a recent study published in the Journal of the American Medical Informatics Association.

While EHRs are increasingly relied upon by physicians to provide critical patient information during examination and at the point of prescribing, a common problem known as alert fatigue can cause doctors to override drug allergy notifications as irrelevant, said Maxim Topaz, PhD, and his co-authors from Brigham and Women’s Hospital in Boston.

“Ignoring alerts can potentially lead to patient harm and other unintended consequences, thus many efforts are underway to improve the accuracy of the alerts and reduce clinicians’ alert fatigue,” they wrote. “Unfortunately, little is known about the acceptance rates and other aspects of drug allergy alerts presented to providers.”

For the study, Topaz and his colleagues performed a retrospective observational cross-sectional study of drug allergy alert data collected between 2004 and 2013 from their own facility as well as from Massachusetts General Hospital.  

They found that the rate of drug allergy alert overrides increased from 84 percent to 88 percent over that 10-year span. Alerts for immune mediated reactions were overridden 73 percent of the time, while life threatening reactions with definite allergen and prescribed medication matches were overridden 74 percent of the time.

“Over the past decade, we identified an alarming trend of constantly increasing rate of drug allergy alert overrides,” the researchers wrote. “The drug allergy alert override rates were high for both potentially immune mediated or life threatening reactions.”

Based on their results, Topaz and his colleagues called for more research into escalating override rates and the underlying reasons behind physicians’ fatigue concerning drug allergy alerts.

“Our findings underline the urgent need for more efforts focused on providing more accurate and relevant drug allergy alerts for providers to decrease alert overrides and alert fatigue,” the authors concluded. “Further investigation is needed into providers’ reasons for overriding drug allergy alerts.”