Quality & Patient Safety

Physicians override CPOE system warnings 80% of the time, study says

Patient Safety Monitor Alert, September 8, 2004

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Physicians override 80% of alerts generated by computerized physician order entry systems (CPOE), according to a study in the Journal of the American Medical Informatics Association.

Researchers at Boston's Brigham and Women's Hospital reviewed 7,761 alerts on CPOE systems and found that physicians overrode 6,182 (80%) of them in 1,150 patients.

Few of the overrides (6%) resulted in adverse drug events (ADEs). Nearly half (47%) of the ADEs were serious. None of the ADEs were considered preventable, however, because the overrides were deemed clinically justifiable.

The physicians' most common reasons for overriding the alerts were:

  • "Aware/Will monitor" (55%)
  • "Patient does not have this allergy /tolerates" (33%)
  • "Patient taking already" (10%)

The researchers recommend that hospitals increase the specificity of CPOE drug allergy alerts, "thereby improving the clinical utility of the drug-allergy alerting system."



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