Allergy alerting and overrides for opioid analogues across two health systems
Objectives Despite opioids comprising a majority of drug allergy alert (DAA) overrides, few studies have designed recommendations for clinical decision support (CDS) systems. We determined the frequency of opioid analogue DAA overrides and assessed DAAs overridden by patient and provider type, the m...
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BMJ Publishing Group
2025-05-01
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| Series: | BMJ Health & Care Informatics |
| Online Access: | https://informatics.bmj.com/content/32/1/e101259.full |
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| author | David W Bates Li Zhou Kimberly G Blumenthal Diane L Seger Rachel L Wasserman Heba H Edrees Foster R Goss Ying-Chih Lo Sheril Varghese Liqin Wang Suzanne Blackley |
| author_facet | David W Bates Li Zhou Kimberly G Blumenthal Diane L Seger Rachel L Wasserman Heba H Edrees Foster R Goss Ying-Chih Lo Sheril Varghese Liqin Wang Suzanne Blackley |
| author_sort | David W Bates |
| collection | DOAJ |
| description | Objectives Despite opioids comprising a majority of drug allergy alert (DAA) overrides, few studies have designed recommendations for clinical decision support (CDS) systems. We determined the frequency of opioid analogue DAA overrides and assessed DAAs overridden by patient and provider type, the most common allergic reactions documented in electronic health records (EHR), reaction severity, and associated hypersensitivity.Methods We conducted an observational cross-sectional study of DAAs in two geographically remote health systems. Patients were included if they were 18 years or older and had an opioid DAA generated when a medication was ordered. Patient and provider demographics, drug allergies, medication ordered, alert overrides, drug allergy reactions and DAA history were collected. Opioid analogue allergies were analysed by reaction type documented in the EHR, reaction severities (high, medium or low) and hypersensitivity reaction. Based on these factors, alerts were recommended to be interruptive requiring a coded response or changed to be non-interruptive (informational).Results There were 700 493 alerts concerning opioid analogues fired for 50 527 patients across both sites, and 71.8% of these alerts were overridden. Nearly three-quarters of overridden reactions had a low to medium severity level at both institutions. Only 29.3% of the overridden alerts were truly immune-mediated.Discussion Our recommendations would reduce interruptive alerts in half by converting them to non-interruptive alerts (46.4%). The data suggest opportunities to improve opioid-related CDS systems.Conclusions We evaluated overrides of opioids and used this data to suggest ways to redesign DAAs to decrease alert override rates, combat alert fatigue and improve patient safety. |
| format | Article |
| id | doaj-art-0ea3e66a32bf4274b64ecd4bfe247b9a |
| institution | OA Journals |
| issn | 2632-1009 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Health & Care Informatics |
| spelling | doaj-art-0ea3e66a32bf4274b64ecd4bfe247b9a2025-08-20T02:34:10ZengBMJ Publishing GroupBMJ Health & Care Informatics2632-10092025-05-0132110.1136/bmjhci-2024-101259Allergy alerting and overrides for opioid analogues across two health systemsDavid W Bates0Li Zhou1Kimberly G Blumenthal2Diane L Seger3Rachel L Wasserman4Heba H Edrees5Foster R Goss6Ying-Chih Lo7Sheril Varghese8Liqin Wang9Suzanne Blackley10Harvard Medical School, Boston, Massachusetts, USADepartment of General Surgery, Peking Union Medical College Hospital, Beijing, Beijing, ChinaDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA3 Clinical and Quality Analysis, Mass General Brigham, Somerville, Massachusetts, USAMassachusetts College of Pharmacy and Health Sciences, MCPHS University, Boston, Massachusetts, USA1 Department of Medicine, Brigham and Women`s Hospital, Boston, Massachusetts, USADepartment of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USADepartment of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USADepartment of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USADepartment of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USAHarvard Medical School, Boston, Massachusetts, USAObjectives Despite opioids comprising a majority of drug allergy alert (DAA) overrides, few studies have designed recommendations for clinical decision support (CDS) systems. We determined the frequency of opioid analogue DAA overrides and assessed DAAs overridden by patient and provider type, the most common allergic reactions documented in electronic health records (EHR), reaction severity, and associated hypersensitivity.Methods We conducted an observational cross-sectional study of DAAs in two geographically remote health systems. Patients were included if they were 18 years or older and had an opioid DAA generated when a medication was ordered. Patient and provider demographics, drug allergies, medication ordered, alert overrides, drug allergy reactions and DAA history were collected. Opioid analogue allergies were analysed by reaction type documented in the EHR, reaction severities (high, medium or low) and hypersensitivity reaction. Based on these factors, alerts were recommended to be interruptive requiring a coded response or changed to be non-interruptive (informational).Results There were 700 493 alerts concerning opioid analogues fired for 50 527 patients across both sites, and 71.8% of these alerts were overridden. Nearly three-quarters of overridden reactions had a low to medium severity level at both institutions. Only 29.3% of the overridden alerts were truly immune-mediated.Discussion Our recommendations would reduce interruptive alerts in half by converting them to non-interruptive alerts (46.4%). The data suggest opportunities to improve opioid-related CDS systems.Conclusions We evaluated overrides of opioids and used this data to suggest ways to redesign DAAs to decrease alert override rates, combat alert fatigue and improve patient safety.https://informatics.bmj.com/content/32/1/e101259.full |
| spellingShingle | David W Bates Li Zhou Kimberly G Blumenthal Diane L Seger Rachel L Wasserman Heba H Edrees Foster R Goss Ying-Chih Lo Sheril Varghese Liqin Wang Suzanne Blackley Allergy alerting and overrides for opioid analogues across two health systems BMJ Health & Care Informatics |
| title | Allergy alerting and overrides for opioid analogues across two health systems |
| title_full | Allergy alerting and overrides for opioid analogues across two health systems |
| title_fullStr | Allergy alerting and overrides for opioid analogues across two health systems |
| title_full_unstemmed | Allergy alerting and overrides for opioid analogues across two health systems |
| title_short | Allergy alerting and overrides for opioid analogues across two health systems |
| title_sort | allergy alerting and overrides for opioid analogues across two health systems |
| url | https://informatics.bmj.com/content/32/1/e101259.full |
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