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Peer Survey of Alert Fatigue in Physicians in a Large Inner City Training Hospital: Does It Affect Drug Allergy Surveillance?
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Adam El Sehamy, MD, Naureen Kabani, MD, Amanda Nussdorf, BS., YiFeng Chen, M.D., Rauno Joks, MD
Rationale:

Electronic decision support (e.g. CPOE Alerts) is designed to help prevent errors  and promote efficiency and safety with EMR. However, physicians may overlook frequent notifications with resultant adverse effects, including drug allergic reactions. Prevalence of this  alert fatigue (AF) in physicians-in–training is understudied. We determined knowledge and manifestations of AF in resident and attending physicians at a large inner city hospital.

Methods:

De-identified written surveys were completed by 105 physicians, resident (n=88)(PGY-1 to PGY-5) and attending (n=17), who were queried about 1) knowledge of, and 2), if knowledgeable, whether they “suffered” from AF. Percent of override of 1) drug interactions, 2) drug allergy, 3) duplicate order, and 4) discontinued orders and history of “near miss” (NM) was determined. Data were analyzed using Mann-Whitney 2-sided test and Fisher’s exact test.

Results:

About two-thirds (66/105) had knowledge of AF, which was associated with significant increase in override of alerts for duplicate (p=0.02) and discontinued (p=0.02), but not drug interactions (p=0.90) or drug allergy (p=0.09). Knowledge of AF was not associated with increased NM (p=0.15) or PGY level (p=0.34).

Of those with knowledge of AF, those who suffer (55/65), did not significantly override any type of alert more than those who don’t suffer (p= 0.81, 0.16, 0.12, and 0.79, respectively), have more NM (p=1.0), or be affected by PGY level (p=0.12).

Conclusions: Knowledge of, but not the emotional response to, AF was associated with increased overrides in orders which may decrease efficiency, but not result in adverse drug effects, including allergic drug reactions.