Study: Doctors Wade Through Unnecessary Opioid Alerts In The ER

November 17, 2015

To detect and prevent just one unwanted medication reaction, emergency room doctors deal with more than 123 unnecessary electronic alerts, according to a new study from University of Colorado School of Medicine

The excessive alerts are part of a commercial electronic health record system that's very common in hospitals across the United States, says one of the study's authors, University of Colorado Hospital Physician Andrew Monte. 

Inside a hospital's walls, the system is designed to stop as many potentially dangerous prescribing actions as possible by alerting the doctor. Those reactions could be anything from mild nausea to something more severe like an allergic reaction or difficulty breathing. 

By design, this system is very sensitive, so it can flag as many unwanted reactions as possible. However, the study finds that many alerts are "clinically insignificant" as a result.

"For instance, if a patient has said that they get nauseous if they get ibuprofen, we may still want to give ibuprofen because it may be the best pain medication for them, and perhaps the safest pain medication for them," Monte said. It's like trying to drive to work and having a stop sign every 10 feet, he adds. At some point, you start to roll through the stop signs so you can get to work. But that can be dangerous. 

"A physician may start to click through them rather than actually thinking about the ramification of dismissing these alerts," Monte said. "I would contend that the alert system needs to be smarter."

For opioids, that could mean factoring in how much a patient has received, instead of just how many times the doctor has prescribed a treatment. 

"Each time you order another dose, the system fires an alert. So, if I order two dose of 1 millimeter of morphine, than that actually fires an alert for 'duplicate therapy.' However, if you just order a dose of 2 millimeters of morphine, no alert is fired."

In the end, less can be more, Monte says.

"Providing more information ultimately makes it more difficult for physicians in some instances."

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