TABLE 6-2 Sample of Alert Types, Most Common Occurrences, and Most Common Reasons for Alert Override

Alert Type

Most Common Occurrences of Highest Alerts

Most Common Reasons for Alert Override

Therapeutic duplication

  • Analgesic (29%)

  • Psychiatric (26%)

  • Gastrointestinal (19%)

  • Cardiac (17%)

  • Endocrine (9%)

  • Transitioning from one drug to another (42%)

  • Long-term therapy with combination (21%)

  • Short-term combination (7%)

  • Advice from consultant (5%)

Drug–drug interaction

  • Sildenafil and isorbide mononitrate

  • Gatifloxacin and levofloxacin

  • Linezolid and methylphenidate

  • Clinician would monitor patient (49%)

  • Patient previously tolerated drug (21%)

  • Clinician would adjust dose as recommended (14%)

  • No reasonable alternatives (4%)

Drug– laboratory

Not documented

  • Clinician would monitor/ manage as recommended (67%)

  • Most recent laboratory test results available (18%)

  • Patient on dialysis (11%)

Drug– disease

  • Hepatic disease contraindications

  • Seizure disorder contraindications

  • Coronary artery disease contraindications

  • Patient previously tolerated drug (56%)

  • New evidence for use (22%)

  • Advice from consultant

  • No reasonable alternative (11%)

Drug– pregnancy

  • Isotretinoin

  • Leflunomide

  • Misprostol

  • Patient is not pregnant (93%)

  • Advice from consultant (1%)

  • No reasonable alternative (1%)

  • Patient previously tolerated drug (1%)

  • Short-term use (1%)

SOURCE: Shah et al., 2006

imply that known dangerous drug interactions or contraindications will change; instead, they reflect a recognition that in some cases, certain clinical preferences should take precedence. Thus, ranking of alerts according to all three dimensions—severity, frequency, and clinical importance—is necessary.

Intelligent Prompting

Technology that could use intelligent or intuitive mechanisms to prompt alerts would require the application of additional parameters beyond sever-



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