Observational studyDrug safety2019
Evaluation of Harm Associated with High Dose-Range Clinical Decision Support Overrides in the Intensive Care Unit.
Observational study in Drug safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Effect of electronic drug-drug interaction alerts on patient and clinician outcomes: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2025Pooled it
- Verification of the value of optimization of the medication-related clinical decision support system in China, a hospital-based study.JAMIA open · 2026Article
- Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling.JAMIA open · 2025Article
- Challenges to Reduce Alert Burden Using Current Decision Support Infrastructure in Two Commercial EHR Systems: Lessons Learned and Path Forward.Applied clinical informatics · 2025Article
- New Performance Measurement Framework for Realizing Patient-Centered Clinical Decision Support: Qualitative Development Study.Journal of medical Internet research · 2025Article
- High alert medications off the radar: A systematic review.Exploratory research in clinical and social pharmacy · 2025Review
- Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach.Critical care explorations · 2023Article
- Medication Errors and Patient Safety: Evaluation of Physicians' Responses to Medication-Related Alert Overrides in Clinical Decision Support Systems.Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2021Article
- Alert Override Patterns With a Medication Clinical Decision Support System in an Academic Emergency Department: Retrospective Descriptive Study.JMIR medical informatics · 2020Article
- Repurposing Clinical Decision Support System Data to Measure Dosing Errors and Clinician-Level Quality of Care.Journal of medical systems · 2020Article
- Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review.JMIR medical informatics · 2020Review
- Structured override reasons for drug-drug interaction alerts in electronic health records.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- The Effect of Eliminating Intermediate Severity Drug-Drug Interaction Alerts on Overall Medication Alert Burden and Acceptance Rate.Applied clinical informatics · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 1 institution in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionMedication-related clinical decision support (CDS) alerts have been shown to be effective at reducing adverse drug events (ADEs). However, these alerts are frequently overridden, with limited data linking these overrides to harm. Dose-range checking alerts are a type of CDS alert that could have a significant impact on morbidity and mortality, especially in the intensive care unit (ICU) setting.
methodsWe performed a single-center, prospective, observational study of adult ICUs from September 2016 to April 2017. Targeted overridden alerts were triggered when doses greater than or equal to 5% over the maximum dose were prescribed. The primary outcome was the appropriateness of the override, determined by two independent reviewers, using pre-specified criteria formulated by a multidisciplinary group. Overrides which resulted in medication administration were then evaluated for ADEs by chart review.
resultsThe override rate of high dose-range alerts in the ICU was 93.0% (total n = 1525) during the study period. A total of 1418 overridden alerts from 755 unique patients were evaluated for appropriateness (appropriateness rate 88.8%). The most common medication associated with high dose-range alerts was insulin regular infusion (n = 262, 18.5%). The rates of ADEs for the appropriately and inappropriately overridden alerts per 100 overridden alerts were 1.3 and 5.0, respectively (p < 0.001).
conclusionsOverriding high dose-range CDS alerts was found to be common and often appropriate, suggesting that more intelligent dose checking is needed. Some alerts were clearly inappropriately presented to the provider. Inappropriate overrides were associated with an increased risk of ADEs, compared to appropriately overridden alerts.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.