{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:04:49Z","timestamp":1770750289789,"version":"3.50.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,4,26]],"date-time":"2020-04-26T00:00:00Z","timestamp":1587859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"IBM Watson Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The study sought to determine frequency and appropriateness of overrides of high-priority drug-drug interaction (DDI) alerts and whether adverse drug events (ADEs) were associated with overrides in a newly implemented electronic health record.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective study of overridden high-priority DDI alerts occurring from April 1, 2016, to March 31, 2017, from inpatient and outpatient settings at an academic health center. We studied highest-severity DDIs that were previously designated as \u201chard stops\u201d and additional high-priority DDIs identified from clinical experience and literature review. All highest-severity alert overrides (n\u2009=\u2009193) plus a stratified random sample of additional overrides (n\u2009=\u2009371) were evaluated for override appropriateness, using predetermined criteria. Charts were reviewed to identify ADEs for overrides that resulted in medication administration. A chi-square test was used to compare ADE rate by override appropriateness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 16\u00a0011 alerts presented to providers, 15\u00a0318 (95.7%) were overridden, including 193 (87.3%) of the highest-severity DDIs and 15\u00a0125 (95.8%) of additional DDIs. Override appropriateness was 45.4% overall, 0.5% for highest-severity DDIs and 68.7% for additional DDIs. For alerts that resulted in medication administration (n\u2009=\u2009423, 75.0%), 29 ADEs were identified (6.9%, 5.1 per 100 overrides). The rate of ADEs was higher with inappropriate vs appropriate overrides (9.4% vs 4.3%; P\u2009=\u2009.038).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The override rate was nearly 90% for even the highest-severity DDI alerts, indicating that stronger suggestions should be made for these alerts, while other alerts should be evaluated for potential suppression.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocaa034","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T12:39:32Z","timestamp":1584016772000},"page":"893-900","source":"Crossref","is-referenced-by-count":47,"title":["High-priority drug-drug interaction clinical decision support overrides in a newly implemented commercial computerized provider order-entry system: Override appropriateness and adverse drug events"],"prefix":"10.1093","volume":"27","author":[{"given":"Heba","family":"Edrees","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA"}]},{"given":"Mary G","family":"Amato","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA"},{"name":"Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care; Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}]},{"given":"Adrian","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA"},{"name":"Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care; Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}]},{"given":"Diane L","family":"Seger","sequence":"additional","affiliation":[{"name":"Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care; Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Clinical and Quality Analysis, Information Systems, Partners HealthCare, Somerville, Massachusetts, USA"}]},{"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care; Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Clinical and Quality Analysis, Information Systems, Partners HealthCare, Somerville, Massachusetts, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA"}]}],"member":"286","published-online":{"date-parts":[[2020,4,26]]},"reference":[{"key":"2020110613094335800_ocaa034-B1","volume-title":"Preventing Medication Errors: Quality Chasm Series","year":"2007"},{"issue":"25","key":"2020110613094335800_ocaa034-B2","doi-asserted-by":"crossref","first-page":"2526","DOI":"10.1056\/NEJMsa020847","article-title":"Improving safety with information technology","volume":"348","author":"Bates","year":"2003","journal-title":"N Engl J Med"},{"issue":"5","key":"2020110613094335800_ocaa034-B3","doi-asserted-by":"crossref","first-page":"217","DOI":"10.5694\/j.1326-5377.2003.tb05166.x","article-title":"Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials","volume":"178","author":"Bennett","year":"2003","journal-title":"Med J Aust"},{"issue":"1","key":"2020110613094335800_ocaa034-B4","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/2046-4053-3-56","article-title":"The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis","volume":"3","author":"Nuckols","year":"2014","journal-title":"Syst Rev"},{"issue":"7","key":"2020110613094335800_ocaa034-B5","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s11606-012-1987-7","article-title":"Impact of vendor computerized physician order entry in community hospitals","volume":"27","author":"Leung","year":"2012","journal-title":"J Gen Intern Med"},{"issue":"2","key":"2020110613094335800_ocaa034-B6","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/jamia\/ocw114","article-title":"Variation in high-priority drug-drug interaction alerts across institutions and electronic health records","volume":"24","author":"McEvoy","year":"2017","journal-title":"J Am Med Inform Assoc"},{"key":"2020110613094335800_ocaa034-B7"},{"issue":"2","key":"2020110613094335800_ocaa034-B8","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1197\/jamia.M1809","article-title":"Overriding of drug safety alerts in computerized physician order entry","volume":"13","author":"van der Sijs","year":"2006","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"2020110613094335800_ocaa034-B9","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1001\/archinternmed.2008.551","article-title":"Overrides of medication alerts in ambulatory care","volume":"169","author":"Isaac","year":"2009","journal-title":"Arch Intern Med"},{"issue":"3","key":"2020110613094335800_ocaa034-B10","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1136\/amiajnl-2013-001813","article-title":"Overrides of medication-related clinical decision support alerts in outpatients","volume":"21","author":"Nanji","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"12","key":"2020110613094335800_ocaa034-B11","doi-asserted-by":"crossref","first-page":"e85071","DOI":"10.1371\/journal.pone.0085071","article-title":"Are we heeding the warning signs? 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